Month: November 2022

It’s that time of year when the clatter of charity boxes fills the air as so many charities compete for our attention. Especially this year, when we can barely afford to feed ourselves, the charities seen especially sharp pricks to the conscience. Just when we were beginning to be comfortable with the idea of cutting back on superfluous expenditure – and that includes for the purposes of this discussion charity donations – than we are accosted by earnest young men called Tristan or Sebastien in floral tabards outside Sainsbury’s, anxious to explain the importance of the charity and why it should be particularly deserving of our support.

In case you ever need to know about providing proper treatment for traumatised donkeys (or it comes up as a question in the pub quiz) PTSD is rife amongst the retired donkey population.

Apparently.

And when questioned by Tristan about the lives of these donkeys, he paints (with the help of a folder filled with pictures of some very glum donkeys). I reach for a fiver in my pocket. He reacts like a Bateman cartoon, affronted that I should do something so vulgar. No, he wants me to sign up to pay a pound a month or whatever it is.

I’m happy to hand over a fiver to assuage my conscience but I balk at making a long-term commitment to Eeyore. Tristan doesn’t give up that easily. He assures me that I can cancel at any time. But then Sky said much the same and it’s taken me nearly a month to rid myself of the last vestiges of them and their satanic satellites. I reassure Tristan that I am interested in supporting these unhappy ungulates but I will need to check out some details first on their website. Apparently they don’t have a website. Peals of alarm bells ring out.

The same day I am approached by the Cats protection league (I didn’t know there was such a thing), a charity aiming to rehouse immigrant families down on their luck, one about rare childhood cancers, and the usual Injured Jockeys Association, Cure Parkinson’s and RNLI.

A total, including the nondigital donkeys, of seven charities in one day. So what do you do? A fiver to each (or at least those who will take your money)? Or should I give more to some than others? Who is the more deserving? And how could you even begin to decide?

Let’s have a go. Bottom of the pile is the Cats protection league. Well, and this should bring down the hate mail like lava from a volcano, I don’t give them a very high ranking. I should probably declare my hand here. I don’t like cats. Never have. Had it been dogs, that would be different. But cats go to the bottom of the pile. For the moment at least.

What comes next? I guess it has to be the donkeys. On the basis that we should probably put human charities above animals. Or should we? I have watched jockeys in action and not been impressed. Whipping animals bred purely for our pleasure as a vehicle for betting doesn’t seem to me to be something I would wish to support. I don’t wish injury on anyone but horses are relatives of donkeys and I feel the need to strike a blow for the donkeys. Sorry jockeys, wrong place at the wrong time. You are now nestling between the cats and the donkeys.

Okay, the next rung on the ladder of misery is probably the RNLI. I think really this harks back to our imperialist yearnings propped up by a long naval tradition. Don’t get me wrong – the RNLI does indeed do a wonderful job for those who need it. But how many actually do? How many people each year are rescued by lifeboats? It’s somewhere in the region of 400 lives (human) each year saved by the lifeboats. And some animals although I don’t have a breakdown for donkeys.

Parkinson’s? I can hardly be expected to answer that one. Yes, Parkinson’s is indeed rubbish. It’s no fun to have. So yes I would like to see a cure. That would prevent more than a thousand deaths each year. But is it more deserving somehow than the 400 saved by the lifeboats. Parkinson’s is, after all (and we can argue over the details as much as we like) still mainly a disease of old age, of people who have had some sort of life at least. I don’t know for a fact but I guess that most of those lives saved by lifeboats are probably younger people, adventurers given a second chance.

You have to factor in quality of life, duration of life saved and the whole bundle of other policy assessments that make for some very heavy mathematics. And if you go down that route, where do you put the rare childhood cancers? Many of those lives are snuffed out so early that it is impossible to assess what they might have become. But there are very few. Should I factor that into my calculations? I just wish I had paid more attention in bioethics class.

Humans and animals? It’s not really possible to answer these questions. Do you distribute your dosh proportionally, giving more to childhood cancer research than unwanted moggies? And what about those website-free donkeys? Or do we ignore distribution and simply give whatever we have in our pockets to whoever appears in front of us?

Don’t ask me. These are questions for God and gods.

In any case, I love cats. But I can never finish a whole one…

When I was sent to boarding school at Marlborough, it was instilled in us from day one that we were expected to be competitive both academically and on the playing fields and athletics track. I needed no telling. For the previous 13 years my father had instilled in me his intense competitive streak.

“It’s not the winning, it’s the taking part” my mother would counterpoint in order to perhaps blunt my father’s innate competitiveness. My father’s notion of competition was very much along the lines of lots of boys taking part in sporting events but with the Stamfords winning. This in turn became his own personal mantra some years later of “family first, everyone else nowhere”. There was no sporting or competitive event too small for him to take an interest if there was a better than evens chance of winning. Before the egg and spoon race, he would check out the eggs and spoons for the appropriate weight, shape and degree of depth and brief his offspring accordingly.

“Okay Jonathan, it’s a shallow teaspoon with a size 3 hens egg, slightly blunted. Try to get thee speckled one. Don’t go off too fast – let the others go ahead at a faster pace. Their eggs will fall off. Keep your speed steady but not maximum. Look to close in over the last ten yards. Got it?”

I nodded. I was four.

I tried to focus but with the best will in the world it was a lot of information to take in for a four year old. If I won I would get a brief but affectionate tousling of the hair. If I lost I got my mother’s voice instead with the bit about taking part. Either way I would still get my father’s analysis.

And God help us if we stepped outside the rules (even of the egg and spoon race). He abhorred cheating. Competition meant nothing if you cheated. Stern dressing downs followed any whiff of impropriety, any hint of a misdemeanour. He would punish us with that most brutal of sanctions, his disinterest. He would take no further interest in any sport or competition in which we had cheated. Which was very very few.

But it worked. I am competitive in many areas of life – in sport (stop laughing), research et cetera. Even writing – I want my writing to be appreciated, for it to be competitive with the best. I know I’m not there yet. I can think of plenty of writers whose books I admire but know that I cannot reach their pinnacles. But I try. I am my father’s son. I hope I have inherited the best of him and not the more tetchy withdrawn version of his last few years as a widower. It was not how he wanted it.

I make my father sound a tyrant, remote and disengaged. Nothing could be further from the truth. He had ways of rewarding us children with his interest. He had a way of making our world his. If we were interested in cricket or football he would make sure he was knowledgeable enough to be part of the conversation. He would ask for my thoughts on Edrich or Boycott as openers for England, whether Tommy Smith was too impetuous at full-back for Liverpool, whether it would be Connors or Rosewall at Wimbledon.

What we didn’t realise was that he was sharpening our social skills. He despised knee-jerk responses to questions. He wanted us to reason and argue. It was an education far greater than I was aware of at the time. Those lessons have stuck with me throughout my life. And those of my brother and sister.

And we are competitive even within the family. For instance I played intermittently for my local village’s 4th XI. My brother had a trial for Yorkshire, even bowling a future test opener in his short spell. My son appears to have acquired his uncle’s rather than his father’s cricketing skills.

Basically, we were competitive kids and became competitive adults.

I don’t know why I seem to have exempted my mother from all this, perhaps conveying – erroneously as it happens – the notion that she believed only in taking part. But in her own ways she was every bit as fierce a competitor. A game of Scrabble or canasta brought out the worst in her. She took defeat badly and was known to upend the Scrabble table when facing defeat.

Only once did she accept a defeat when playing an ageing Dowager aunt from Pietermaritzburg who played Scrabble to an almost international level. She would visit us for a month every summer, driving my mother to distraction and subjecting her to daily linguistic beatings. On the last day of her holiday before we shipped the old bat out to South Africa again, my mother had the letters in her hand to win the game but generously and perhaps wisely chose not to win. I still don’t think that aunt Ivy was quite ready for CLITORIS across a triple word score.

Every day I take levodopa, rasagiline, entacapone, carbidopa, propranolol, metformin, simvastatin, benserazide, clonazepam, rotigotine and a modest number of vitamin supplements. These amount to 19 tablets/capsules/patches usually at six timed intervals. That’s 133 a week, 6935 a year. Yes, count them.

Some are delivered to me in bottles, others in those infernal blister packs which seem to serve little purpose other than to destroy one’s nails. They certainly don’t make it easy.

And they come in pretty much every colour of the rainbow, albeit with a preponderance of white. My propranolol tablets are a rather fetching pink (usually – occasionally they are white thus making them indistinguishable from the amitriptyline tablets of the same dose and in identical packaging) and have the letters embossed on them although you would need the magnification of the Hubble space telescope to read them, so minuscule are they.

Two tablets, on the face of it identical, are apparently distinguishable as well. Clonazepam (pale whitish peach) and simvastatin (pale peachy white) I understand can be distinguished from each other by their embossed lettering. Clonazepam also has a kind of score mark down the middle. No chance of a drug error there then.

I’m told that you can have your daily tablets lovingly sealed into your own personal blister packs by your pharmacist should you so wish. Also, bearing in mind just had diabolically difficult blister packs can be, deliberately sequestering one’s medication into such an inaccessible format seems perverse.

Moreover the resulting blister packs (certainly those that I’ve seen) are virtually the size of an A4 document wallet. And secondly, as was the case this month, pharmacists make mistakes. In this case they managed to double the dose of one of my drugs. Oh well, that’s life (or death).

There are some medications where this makes little difference but in the case of others can have serious consequences. At the end of the day it is quite important to be able to distinguish your different drugs especially when, as in my case, there are so many.

There is also the psychology of colour to factor in. For example, drugs affecting the heart and circulation tend to be red, orange or yellow – bright colours for brighter days. Conversely drugs affecting the mind and brain tend to be more muted – muted purples and blues, perhaps hinting at the dark arts of psychopharmacology and neuropharmacology.

These are not just mere flights of fancy. The colours and shapes of tablets to reflect marketing considerations and integral part of the overall promotion [1]. A recent paper found that different shapes of tablet also has an effect on patient responses [2].

Of course little of this applies to generic drugs. Once a drug’s patent expires it is a free for all. Every Tom, Dick or Harry can make and market their own version of Sinemet. And they don’t have to make it even look like the original’s comforting pastel pink and baby blue capsules.

Generic drugs are a minefield in terms of regulation. But that’s for another day.

[1] Drug Tablet Design: Why Pills Come in So Many Shapes and Sizes. https://ftloscience.com/drug-tablet-design/

[2] Olesya Blazhenkova, Kivilcim Dogerlioglu-Demi. The shape of the pill: Perceived effects, evoked bodily sensations and emotions. PLoS One. 2020; 15(9): e0238378. published online 2020 Sep 8. doi: 10.1371