When the hinterland bites back

Suppose I have reason not to trust doctors, and general practitioners (GPs) in particular. Not a particular doctor, though that will always be true, but where GPs are coming from, what they have been taught, the tools they use and the data they rely on.

They are often engaging, even charismatic, people who seem interested in me and my health: but only from a particular angle. You can get at this issue very quickly by examining informed consent. The things doctors promote to their patients are many times with hindsight not a great idea and patients are almost always not in a position to take a good decision about their own health. Indeed, it would be odd for any professional to give their clients the information to be able to challenge their advice.

You can get a different take on the same issue by looking at the patients who want to be given some pills to make them better. There is a huge increase in prescriptions of pills for mental health issues: depression, sleeping problems, anxiety. There is no sign that this prescription in effective over time and lots of evidence that people are addicted and damaged: doctors seem to say that they will prescribe a very small dose, so that’s OK then. The things that might help patients who say they just want a pill are dietary and exercise programmes that doctors are much less good at selling. We trust GPs with poisons but not with our lives and the way we live them.

The contexts for this situation are not helpful. Pharmaceutical companies are rich and powerful and control the media tightly, so there is little useful information available from everyday public sources. Medical education is extremely conservative and slow to change — it is also corrupt. And the majority of the population in the UK is now metabolically unhealthy, so the experience of doctors is overwhelmingly of patients whose metabolism does not work properly.

Just to explore this last. There is a high level of concern about the link between salt intake and hypertension, and there is indeed a link in the data. However, people who do not have raised insulin levels can process salt without problems and excrete any excess. Indeed, more salt is necessary once metabolic problems have been sorted. The slogan is “don’t blame the salt for what the sugar does” and indeed you can easily reduce hypertension by going keto.

Destroying the hinterland

All civilisations to date have collapsed when their hinterland can no longer support their population, usually through destruction of the soil. We are a million miles from learning this lesson. Both literally as we turn the agricultural land of the world into deserts, and metaphorically by ignoring the destruction of other things we depend on like social infrastructure and trust.

Yes, I am saying that doctors have come from being a factor in the effective management of illness and disease to being a factor in the destruction of general public health. They don’t quite recognise yet that they are actively destroying patient trust in them and their system. They know but don’t know that health research in the UK is thoroughly Stalinist. They know but don’t know that they are being bribed to push medicines that don’t work.

This is not a benign effect in the margins. If, as is far too common recently, you have a major trauma in your life and you turn to your doctor for support, perhaps in managing to sleep, you will probably be treated as having a mental health condition. Make no mistake: they’ll say your inability to deal with life-threatening trauma is your fault! Take these pills that may result in brain damage and addiction. Let us complete the ruin of your life.

Doctors are not responsible for the collapse of our civilisation, but they are a good example of the destruction of the hinterland without which the civilisation cannot exist. As we speak if you are damaged by a Covid vaccine there is no support available, and many people and institutions will not believe your story. The mainstream media will refuse to cover your story even when handed full verified documentation on a plate. Collapse is in front of our eyes, and we don’t see it, just as previous civilisations refused to see their own future.

Customer care

Obviously the tobacco industry did and still does kill millions of its customers. There is no other way to put it. And it seems the food industry learned its business methods from tobacco: get your customers addicted. Since those addictions are harmful to health — no accident — the food industry kills more of its customers than any other industry. What proportion of the population hold out against breakfast cereals?

We can talk about the alcohol industry; we can talk about gambling. Other people can and do fight those battles, sometimes with some limited success. But the point we are after here is still the destruction of the hinterland: we can see industries literally destroy their customer base and we can see how there is no other business model out there.

There is no governance in these industries that says: hang on we can’t keep doing this indefinitely. And there is no governance that says why does such a pattern exist across industries and still less what can we do about protecting our future.

During the financial crash of 2008, banks kept trading frantically in worthless paper until the crash actually happened. They were ripping people off, but it was party time. The crash resulted in the biggest ever transfer of wealth from black Americans to whites. The focus was on the survival of a rapacious banking system, not on protecting the hinterland.

The oil industry is the prime case. By their own reckoning they are destroying the liveability of planet earth, and despite bold statements their mission keeps reverting to what they know best. We are addicted to cars and to industry that needs cheap energy. We even take gross risks with our national security to feed our addiction.

The hinterland focuses the issue. If we kill our addicted customers, who cares so long as there are enough customers with nowhere else to go? Remember McKinsey advised the Sacklers about how to get more customers addicted to opioids. The climate case is the extreme of hinterland arguments: when the very planet becomes the hinterland it is obvious to everyone who looks that ecocide, genocide are the only outcomes. The fact that people argue about when we might die proves the case.

Tipping points

If the hinterland was steadily degrading so that the policy choices were obvious, at least we would have our eyes open. But these things swing suddenly around tipping points. Ecological collapse happens quite suddenly when it comes. Climate is tied to ocean circulation which seems to be switching. People make wildly ill-informed decisions under stress, perhaps especially politicians do. And it will always be the case that disastrous options are dressed up as salvation, maybe genuinely believed in. Eat vegetables for instance.

Looked at through the other end of the telescope, we do not heed the gradual changes that are perfectly measurable and communicable. We find narratives to comfort ourselves that we do not need to change just yet. That is the behaviour that guarantees tipping points over which we no longer have any control.

If ocean circulation switches to another pattern, there is nothing in the science that says we can get it to switch back to patterns that work for us. Almost nothing of this nature is reversible. Neither can we test policy “options” to see if they “work”. Everything takes us to a new place, and the new hinterland will probably not supply the services we need. We may not like where evolution takes us.

Hinterland

No-one thinks the hinterland matters. Almost by definition it is the part of supporting services that is not thought to be important. Of course, there are many, many ways that life can become unsupportable, and hinterland can be shorthand for the ones we neither know nor care about. If you look at how narrow political agendas have become you can see how corresponding wide and important the hinterland becomes.

This is not a matter of information and reporting. The recent case of lightweight concrete in schools and hospitals (and …) was properly investigated in a timely manner, proper proposals were submitted to take care of the issues, the problems which would be faced by the sheer scale were enumerated: but schools and hospitals were placed, maybe briefly, in the hinterland of things not to worry about until they became someone else’s problem.

The hinterland is a densely interconnected system in the way that a political programme cannot be. All the unexpected interdependencies and gotchas are lying there like landmines and booby-traps. These things have their origins in all the ways we don’t follow through our decisions. Lightweight concrete has a design life of thirty years so … Borrowed time is why things can build to crises and perfect storms.

The governance of hinterland relationships

If the hinterland is, almost by definition, all the things that a civilisation chooses not to pay attention to, what is to be done when the capacity of the hinterland comes into doubt? Who knows when stresses and strains and small failures add up to an existential threat? Well of course the hinterland itself and its denizens know. And those denizens will never be asked in the current scheme of things, which is why civilisations collapse.

If I lose trust in GPs, then nothing will change until the roots of that lack of trust are addressed, until someone can speak to me about the reasons why I do not, cannot, trust my GP. It is not a question of who is right, it is a question of institution and hinterland. The pressures from big pharma and big food are such that this is not a matter of a fireside chat over a pint. The pressures on the system, clearly seen in the furore and fuss around vaccination, become existential for the institution: how could they not, eventually?

The data that GPs use, the evidence if you like, is systematically invalidated by a failure to understand metabolic health, and of course metabolism is necessarily the root of all biology. The so-called crises of obesity, of heart disease, of diabetes, of mental health, of all chronic disease in our population are symptoms of mistaken notions of metabolism. As David Bohm knew so well, a single failure in a system of thought can invalidate the whole edifice. There is nothing that I can say to my GP to bridge this gap.

So, when the ability of the hinterland to support and service a civilisation is crumbling, what is to be done, what are the governance moves and structures? Bridges need to be built. There must be a recognition that from the perspective of a civilisation or an institution there are some risks and wrinkles but from the perspective of the hinterland full scale collapse is in view. And to build a bridge means accepting vulnerability. An institution must understand that its view of itself will get swept away. Of course, people want to circle the wagons.

Exemplars

When South Africa moved away from apartheid, there were elements and stories of bridge building between a repressive government and the bulk of the population that the country consisted of. There was much talk of democracy and its principles, but the nub was some crunchy negotiation about sharing power so that the hinterland could recover somewhat.

In a similar way the GOP in the US has to come to grips with its hinterland, in a way that allows the hinterland to have a voice and to understand the hinterland’s part in taking the country to a better place. The alternative is a disintegration and collapse that we may yet see.

We need to see very clearly that there are no unilateral solutions to the collapse of a hinterland: only proper governance can help.