GemCaley

Great Expectations: The Cost of Misunderstanding the NHS

The NHS has a big problem. I’m not talking about questionable financial management, the dangers of excessive entanglement with the private sector, or even superbugs on the wards. The biggest problem I see in the NHS today is a chronic lack of understanding on the part of the public. The very group of people it was set up to assist is contributing to its downfall.

Sitting in a waiting-room in a hospital department recently, I couldn’t help but overhear some of the comments made by other patients. One gentleman, perusing the reading material set out by the water cooler, complained that the magazines available were old issues. Another voiced the opinion that the department’s nurses didn’t ‘look professional enough’. Yet another, upon hearing that she would be seen by a locum doctor as her usual clinician had been called away on an emergency, demanded to know why she should bother turning up for her appointment if her doctor didn’t.

Expensive uniforms. Robotic medical professionals. Magazine subscriptions. Such are the expectations of a service set up first and foremost to provide decent and affordable healthcare for all who need it. Of what possible relevance would the latest issue of Heat be to your health? How could the last-minute substitution of one doctor for another equally well-qualified one be less convenient than having your appointment cancelled? And why on earth would you think that spitefully missing your appointment would be hurting anyone but yourself?

It’s on this last point that I would like to concentrate – because, actually, you aren’t only hurting yourself. Each missed appointment has a knock-on effect on patients, doctors, and hospital services. Allow me to take you through the process.

Imagine you have an ongoing health problem of some kind. Let’s say it’s a skin condition. It flares up like eczema, but the usual creams and ointments don’t seem to have any effect. You’re scratching your elbows down to the bone and climbing the walls in frustration, so your GP refers you to Dermatology. You are sent an appointment letter from your chosen hospital, asking you to attend on a certain date.

At this point, the following people are already involved in your care:

Your GP, who referred you
A Consultant Dermatologist, who checked over your referral letter to assess whether you had been referred to the correct department
A secretary, who scheduled your appointment, created the letter and sent it to you

These people are paid to work in the NHS. The NHS is paid for through taxes. Taxes are paid by you.

Let’s continue.

So now the wheels have been set in motion. You have your appointment date, but – glory be! – your inflamed skin has miraculously cleared, and you see no need to attend your appointment. Fair enough. It’s your health, it’s your decision. At this point, according to the information detailed in your hospital appointment letter, you contact the Dermatology department to let them know that you no longer need the appointment. They now have an empty slot in that day’s schedule, which they fill by offering it to another patient who needs it, which helps to cut down their waiting-list.

Only… you don’t contact Dermatology. It’s only the NHS, after all – it isn’t like a private medical clinic, or even the dentist, who would charge you if you didn’t give at least twenty-four hours’ notice of cancellation. The NHS doesn’t charge anyone, because it doesn’t actually cost anything.

Before we debate the ridiculousness of that viewpoint, let’s return to our scenario.

We now have two conflicting realities: one, in which you have decided you won’t be attending your appointment, but haven’t let the hospital know this; and two, in which the hospital has arranged for a highly-trained specialist in skin complaints to review you and offer their expert medical opinion in order to help you.

The day of your appointment arrives. Over in the Dermatology department, the receptionist has created a file for you in anticipation of it being filled with notes about your condition. Down the hall, a trained medical professional is waiting in his (or her) office to help you, not knowing that you won’t be turning up. He can’t just call in the next patient, because perhaps you’re running a few minutes late. Perhaps he could use the time to answer some of the many written queries that arrive from GPs and patients every day, but again, he can’t really get stuck into anything, because you might be about to walk through that door.

Any minute, now.

Had you attended your appointment as planned, the clinician would have then dictated a letter to your GP, which would then be typed by the departmental secretary and sent out. Your lack of attendance doesn’t mean that this doesn’t happen. The clinician still dictates a letter to let your GP know that you didn’t attend, and the secretary still types it and sends it. This is part of what is called continuity of care. Communication keeps everyone informed.

Let’s just remind ourselves how many people are currently involved because you asked for help:

Your GP
One secretary
One receptionist
One Consultant Dermatologist

And now for some very rough numbers (because I’m no statistician) – please take the following as averages:

A GP earns around £100,000pa (call it £50/hr) – 15 minutes spent seeing a patient and making the referral therefore costs around £12.50
An NHS secretary earns £23,500pa (call it £12/hr) – 20 minutes spent typing a couple of letters, scheduling an appointment, and printing and sending said letters costs £4 (not counting the cost of stationery and postage)
An NHS receptionist earns £16,500pa (call it £8.50/hr) – 10 minutes making up a file costs around £1.50
A consultant earns around £100,000pa – the initial consultation (or, in our scenario, the vacant slot intended for it), plus time to dictate a letter and make any necessary onward referrals within the hospital network, takes about one hour (often longer, in fact) of their time, at a cost of £50.

That’s £68 wasted, according to this rather conservative estimate of time and money spent. That doesn’t include all those little extras like postage, stationery, electricity. I guess if we wanted to include those we could round this figure up to £70. So that’s £70 of public money – your money – down the tubes every single time a patient does not attend an appointment and doesn’t let the hospital know. Taking into account NHS England’s recent estimate that 6.9 million hospital appointments are missed every year in the UK, that’s a sizeable chunk of public money gone for no good reason.

If we, the public, thought of the NHS as a “real” business, rather than a fantasy world where doctors and nurses toil merrily all day and night for free just for the warm fuzzy feeling of knowing that they’re doing good, we’d more easily be able to compare costs and make the right decision – to spend a few minutes and less than 50p cancelling an appointment by phone, or to waste £70 and a good couple of man-hours by not doing so. It’s a financial no-brainer.

And yet the status quo persists, the NHS continues to haemorrhage money, and many people continue to complain about the services. But is it any wonder some of the waiting-lists are so long if patients habitually miss their appointments and fail to give any notice that a slot has become available? And is it any wonder that so many departments are grossly overspending, given the amount of money wasted on empty appointment slots, rescheduling, and extra letters?

I think so many people miss their appointments because they take the NHS for granted. They see it as a free service that they can take or leave. The money that funds it is taken out of our wages straight off – we never see that money so we don’t see it as a loss when it’s inefficiently spent. It isn’t perceived as being the same as missing a private appointment, where you’re charged for it if you don’t cancel in time and the money comes straight from your own pocket. But it is, in a very real, if less direct, sense, money taken out of your pocket and tipped down the drain. And in the case of missed appointments, it’s a very preventable waste of money.

We take the NHS for granted because we don’t think about how it works. We don’t understand it and we only talk about it when it disappoints us. We make demands of it as if it has limitless funds; we complain about the money being wasted, yet we refuse to acknowledge our part in that wastage. This is our own money we’re throwing away! These doctors and admin staff are here to help you, but they can’t help you if you don’t turn up and they certainly don’t deserve your vitriol when the service you receive is inevitably less than perfect. We need to meet the NHS halfway for it to work efficiently and cost-effectively. We have a responsibility for our own health and a responsibility for our public services. It’s time for each and every one of us to recognise our part in it.

Is This (The Beginning Of) The End Of Prohibition?

Speaking as someone who knows next to nothing about the American lawmaking process – and can therefore be naively optimistic – I’ve had my mental fingers crossed ever since I heard that Colorado and Washington have both voted to legalise cannabis for recreational use. (NB Mental fingers: those things you cross when you really, really want something to happen but you don’t want to have to stop typing.)

Potheads in the two states have been celebrating well in advance of any consent from the Department of Justice, with plans already in place to direct tax money from legal sale of the drug into the construction of schools (oh, to be young enough to enrol in the first real High School) and a range of health programmes including drug and alcohol treatment.

Oregon just lost out on legalising weed – although, with arguably the most liberal initiative of the three states (they wanted unlimited personal amounts and growing privileges), but by far the smallest campaign budget, this outcome is perhaps understandable. Maybe next time, Oregon. I’ve got my mental fingers crossed for you, ‘n all.

Another good piece of pot-related news came in the form of the Mayor of Amsterdam’s announcement (to admittedly negligible surprise) that foreign tourists will not be banned from using the city’s coffee shops. Wasn’t that a lot of worry for nothing – cannabis café owners fretting over the loss of tourism, the Mayor facing the prospect of the city descending into a miasma of dodgy street dealers and shoddy merchandise, not to mention us lot sitting worriedly on the couch in front of the laptop, trying to work out how to fit in another jaunt to Holland before the law came into effect. Worry over, anyway.

All this liberalism has been making me feel just a little bit as though I’m living in some kind of backwater, conservative commune, rather than one of the world’s most awesome global cities. While we’ve been resting back in our creaking leather armchairs, passing the brandy and gently chuckling at the antics of our younger cousin, America’s been getting on with surpassing us in some pretty damn important arenas. Britain upgrades cannabis to Class B, America legalises it first for medicinal and then recreational use. America gets Obamacare, while in Britain we’re in danger of losing our internationally-lauded NHS to the fickle whims of privatisation. Our PM reveals himself to be an immoral wheeler-dealer of war machines to the Middle East, while in America a genius businessman fights to use his enormous wealth to develop clean energy for all. Oh wait, that was Iron Man. But you get the point.

But anyway, back to America. What does this legalisation of pot mean for them? Well, I can’t imagine that the Department of Justice is going to roll over on this one, if its initial, tight-lipped “no comment” reaction is anything to go by. Presumably it will cite precedent, and complain of the difficulties in managing a country in which some states allow the use of a drug while other states battle smuggling issues and criminal activity. Or perhaps it will just bring its big federal boot down and yell “I said NO!” Which would be a shame because, as some have already pointed out, this could be a great opportunity to start to address the longstanding conflict between state and federal laws. It seems bizarre that you can do something that’s both legal and illegal at the same time. Personally, I see this as a case of political and legislative stagnation rather than mere precedent, but surely even two states deciding to legalise cannabis evidences a sea change worthy of review on a federal level? At any rate, the Department of Justice needs to make a decision soon – it would be a phenomenal waste of resources if Washington and Colorado got too far into their implementation and were then told it’d all been for nothing.

A much more immediate issue is, of course, the impact of legalisation on drug cartels. Make something legal, regulate it, keep the quality to a certain standard, make it easily obtainable… why would anyone choose instead to buy off some shifty dealer who may well be bulking out the product with sugar or sand in order to turn a profit – someone who, in turn, has to handle the paranoid people one level up, who sometimes deal in much nastier things than weed and occasionally wave a gun in their face? It’s a no-brainer. Obviously the lords aren’t going to be too happy about it, but any savvy street dealer or home grower with half a brain should be looking to capitalise on the change in law and set up shop legitimately. More money, less risk. Another no-brainer.

Ok, so I’m over-simplifying. There are many knots to be massaged out of this legislation, including how to test for “drug-drivers” without accidentally penalising medical marijuana users (though, to be fair, if you have enough in your system to be considered too impaired to drive, you probably shouldn’t be driving). But this has got medical marijuana users understandably worried – will the tests be good enough, will they be fair? It’s something that needs to be worked out and set in place beforehand in order to avoid wrongful arrests, but it shouldn’t be a permanent barrier to legalisation. Calm down, guys. Put your feet up and have a smoke, why not?

Surprising enough as is opposition to legalisation from those who can already buy and smoke legally, it’s as nothing when compared to the support from anti-drugs campaigners. Funny what the promise of funding for rehab programmes can do to a person’s views – but I guess it’s no weirder than a government taxing alcohol and tobacco and then pushing tax money into a healthcare system that provides treatment for diseases caused by the consumption of alcohol and tobacco. Funny old world, eh? I’m not even going to mention the utter hypocrisy of a system that’s been benefiting from the abuse of certain substances while punishing the use of others. Or add my voice to the millions of those yelling that “the war on drugs isn’t working”. The evidence speaks for itself.

Whatever the outcome in the US, full credit to this significant minority of America that has had an attack of rationality and accepted that the legalisation – and, therefore, regulation – of marijuana is the only way forward in the so-called “war on drugs”. You can’t stop people experimenting with drugs – human beings have been getting high for millennia – but you can do your utmost to ensure that personal risk is minimised, in this case by taking power away from criminals and regulating your product for quality. Oh, and did we forget it can be taxed, just like alcohol and tobacco? Legalised weed is an untapped, potentially hugely lucrative source of revenue for an ailing economy. I wholeheartedly wish that British politicians would stop pandering to the sensationalist media and recognise when to act for the benefit of the people. We’ve got Tories running the show now, for god’s sake – surely they of all people should be able to spot when they’re missing out on a fantastic business opportunity?

The Hidden Squeamishness of UK Doctors (And Why Euthanasia Should be Legal)

Until 1961, attempting suicide in the UK was illegal and punishable by a fine or a short jail term. England was one of the last countries in Europe to decriminalise suicide, but the stigma remains in the minds of many, and I know from recent topical conversations that some people still believe suicide to be illegal, or just plain wrong. So, change happens slowly in Merrie Olde Englande, and confusion abounds.

In view of the outcome of Tony Nicklinson’s court case earlier this month, it seems that UK law is just as slow to change now as it was half a century ago. Why are our MPs and lawmakers so unwilling to discuss the notion of assisted suicide? For Tony, and for the other locked-in syndrome sufferer known only as ‘Martin’, the answer was obviously cowardice – politicians and judges both unwilling to confront real issues, such as the right to die when you are physically unable to take your own life. I would, however, like to add doctors to this short but telling list of the squeamish.

There is, understandably, fear that a change in the law would put vulnerable people at risk (disabled people who have no desire to die, for example), and perhaps images of naughty doctors creeping around care homes with syringes full of barbiturates did dance through the judges’ minds when they concluded that no doctor assisting non-terminally ill patients to die would be immune from prosecution. Of course new laws are vulnerable to abuse, but there is no reason why safeguards could not be implemented when legislating for assisted suicide. Just because you make something legal doesn’t mean you also make it easy. In the case of assisted suicide, the person seeking assistance should be assessed by several doctors independently and each case judged on its own merits with the maximum amount of information and professional advice available. It should be a lengthy process (at the very least, it isn’t one of those snap decisions that you’d be able to renege on at a later date), but the option should exist.

To a certain extent I can excuse the squeamishness of politicians and judges to deal with such an issue (perhaps because I have a lower opinion of them to begin with), but the Royal College of Physicians and the British Medical Association have keenly disappointed me with their views on assisted suicide. In the course of my research for this article I have found myself reading quote after quote in which doctors have asserted their duty to “look after” their patients and provide “good care” for them, but these are fluffy notions that do not entertain the idea that, for a very small minority of patients, death would be “in the patient’s best interests”. Ignoring this as an option is, in my opinion, the mark of a physician not doing their job properly. Perhaps some doctors have lost sight of the extent of the remit of their profession. Sometimes a situation becomes so intolerable for a person that it is not actually in their best interests to keep them alive.

How many times have you heard someone, speaking of a recently departed loved one, comment that their sadness at losing them is somewhat tempered by the knowledge that they are no longer suffering? Surely this is the more humane response – yet as a society we seem more attuned to the suffering of the family pet than a fellow human being. For how long have doctors been terminating pregnancies, switching off life support machines, engaging in passive euthanasia through DNR (“Do Not Resuscitate”) orders, and (in the case of veterinary doctors) putting animals down to end their suffering? Why do they have less problem ending the life of a being that cannot give its opinion on the matter than of one who can actually communicate their desire to die? It makes no sense. Where is the compassion for the human being who is suffering mentally, not just physically?

Despite the great increase in our understanding of mental illness, doctors still seem to prioritise health of the body over health of the mind. They are confident when dealing with conditions of all kinds from which a patient wishes to recover, and even respect a patient’s decision to refuse treatment, but when death is actively sought, they balk. The BMA’s reasons for continuing to oppose a change in the law on assisted suicide amount to little more than the protection of doctors against having to make tough moral decisions and to face up to what HPAD (Healthcare Professionals for Assisted Dying) calls the “clinical reality” – that however small the minority, there do exist patients who wish to end their lives but are unable to do so without outside help. Surely acting in the best interests of a patient should include choosing to assist in their wanted death rather than putting them into a position where, for example, they must resort to starving themselves as a means of ending their life.

We have to learn where to draw a line under our efforts to preserve human life. Do not take this statement out of context – doctors should always do their utmost to prevent death where death is not desired. But to preside over the death of a patient is not a failure or dereliction of duty when not even the patient believes in the worth of such efforts. We just need to make sure that any laws facilitating assisted suicide will never allow someone to “be murdered” without their express desire. And if there is consent, ought it even really to be called “murder”?

This is your Government on drugs!

“The plain fact of the matter is drugs are incredibly addictive, they destroy lives”. So said Tory MP Louise Mensch, successful politician, bestselling author, mother-of-three, wife of Metallica manager Peter Mensch, and former Class A drug user whose dabbling with certain unnamed narcotics has clearly ruined her life. Yes. Ruined. So she’s quitting the low-down, dirty, hand-to-mouth insecurity of political life in the UK and moving to America with the family, where hopefully life will be easier, more tranquil(liser).

Oh, Menschy, why’d you have to go now? By removing yourself from British politics you’re wrenching the linchpin from my argument, to wit, that drug-taking, per se, does not actually ruin lives. I guess I’ll just have to find some other poor down-and-outs to pick on, like David Cameron, Boris Johnson and Alistair Darling, all of whom smoked cannabis in their youth. In fact, a few minutes’ fervent Googling turned up a plethora of drug-related confessions from within the many echelons of British politics – among all these successful, powerful, well-educated people. I particularly liked the views of Tim Yeo (with whom Mensch shares both a political party and alma mater), who is said to have enjoyed the experience of smoking cannabis and thinks that “it can have a much pleasanter experience than having too much to drink.”

I hope Mrs Mensch doesn’t think she’s going to get away from these more liberal views on drugs just by moving to America – a country whose current President famously said of smoking cannabis:

“I inhaled frequently… That was the point.”

And as for some of the others… Bush Jnr abused alcohol (and allegedly cocaine); Clinton admitted to having a couple of puffs on a joint whilst studying in England, but not inhaling or liking it (oh, blame the Brits for leading you astray, eh Willie?); Mayor of New York City Michael Bloomberg was more candid, even going so far as to say that he has enjoyed smoking marijuana in the past. Al Gore and Sarah Palin have both been ‘outed’ in biographies as former dope smokers (add cocaine use to that, in the case of Miss Alaska). This kind of name-dropping is not intended to shame those in the spotlight, but rather to highlight two things: firstly, that dabbling in recreational drugs is extremely common, and secondly, that doing so does not automatically condemn one to a life of petty crime and back-alley blowjobs.

I’m terribly sorry, Louise, but your “plain fact” of my first paragraph is anything but. Drugs can be addictive, and they can be a major factor in “destroying” lives (what a horrible little phrase), but neither one of these claims is absolute. It is, in fact, quite absurd to just lump all controlled drugs in together like that; are we expected to believe that alcohol and heroin are equally addictive, equally life-destroying? Morphine is Class A, but doctors use it to alleviate severe pain in their patients – may I therefore infer that it is the application of the drug, not the drug itself, that we ought to be controlling? Fast food can be just as detrimental to health when ingested to excess, and obesity can and does ruin the lives of those who suffer from it as well as impacting on the lives of those around them; are you intending to ban fat and sugar for all, too?

I’m sure you’ll recall that, about four years ago, the Advisory Council on the Misuse of Drugs (ACMD) presented its conclusions regarding the dangers of cannabis use – conclusions that resulted in the dismissal of the Council’s chairman Professor David Nutt and the resignations of several other members of the ACMD. The problem, in essence, was that the Council’s findings did not support current government policy; against the Council’s advice, cannabis was reclassified as a Class B controlled substance. A study published by Nutt et al. in The Lancet in November 2010 reiterated that, using the multicriteria decision analysis approach (which took into account personal harm, social harm etc.), alcohol is the most harmful substance. I’m using percentages here to represent the study’s arbitrary ‘points out of 100’ scoring system of overall harm: alcohol achieved 72% on this scale, with heroin and crack cocaine ranking second and third respectively at just over the 50% mark. Cannabis was ranked much lower at 20%, making it 6% less harmful than tobacco. Magic mushrooms, LSD and ecstasy can be found huddled at the far end of the chart, each with a score under 10%. I found the scores for LSD and mushrooms particularly interesting because, as well as being of only very slight risk to users, they were deemed to be of absolutely no risk to wider society – and yet both substances are currently Class A, which can get you up to seven years in prison and a hefty fine. Even more interesting is DirectGov’s explanation that drugs are categorised as Class A, B or C “according to how dangerous they are.” Hmm. That’s a lie, isn’t it?

But I digress. The plain fact, Louise, is that just because you don’t like something doesn’t mean it should be prohibited by law. Or, as your fellow Question Time panel member John Lydon observed, “Just because you’ve had a bad time of it… Let us, as human beings, determine our own journey in life.” If you want to keep drugs illegal because of the damage they can do, you should also be fighting to make alcohol and cigarettes illegal, or you’re just being a hypocrite. If you want to allow people to make their own choices based on accurate information made available to them (and, perhaps, turn a tidy profit in tax), you’re going to have to legalise all drugs – or at least the ones proven to be no more damaging than tobacco, alcohol, and over-the-counter pharmaceuticals. But you cannot simply rally against something because it has personally upset you at some point. Your personal experience is not the experience of others, and to legislate based on personal views is to deny experiences to other people. You cannot keep people safe by stopping them from doing any activities that carry any risk. We must defer to evidence, to cold hard facts, and then disseminate this information as clearly as possible, in order to adequately equip those who are determined to take such risks.

I recently came across the notion of “truthiness”, a term coined by American satirist Stephen Colbert (The Daily Show, The Colbert Report) to explain the increasingly popular, and increasingly worrying, trend toward decision-making based on gut feeling rather than facts. Mr Colbert had in mind certain politicians of his own country when he said this, but I can see a very similar trend in the UK. In the case of drug legislation, surely it makes more sense to classify substances according to the harm they do, rather than political agenda, or societal perception (which, let’s face it, is usually based on very little information and sensationalist negativism courtesy of the mainstream media)? If we base policy on evidence instead of opinion, how can there be any arguments?

This Girl-on-Girl Action Ain’t Sexy

I was recently utterly enraged by a couple of articles on the Metro website, which claimed that women should know by now that it is practically illegal to venture out in public without first either shaving or waxing their underarms, and that to transgress this long-established social law is to announce to the world that they are disorganised, dirty, and lacking in self-respect and in that mysterious quality known as “class”. To let other people see your hairy pits, claimed the author, is both disgusting and unacceptable.

The articles focused on the so-called “major beauty faux pas” made by Pixie Lott at the London premiere of the latest Batman movie, at which she flashed a spot of pit fuzz; the journo in question likened it to a similar incident over a decade ago when Julia Roberts proudly aired her (admittedly rather more copious) armpit-carpet at the London premiere of Notting Hill. The photographers went nuts on each occasion, of course, which is why these non-events got in the news.

Stunned that such petty bile could be deemed true journalism, through a red mist I scanned the offending pages. I was looking for the name of this perpetrator of male chauvinism and despicable misogyny, this no doubt doddery old bastion of alpha male behaviour holding out stubbornly against the progressive views of a modern society. And then I found it. Amy Duncan. Hmm, that’s a funny name for a bloke.

Well, it turns out that I’m just plain old naïve – and, in my own way, sexist – because not only is this woman expounding the views I most commonly associate with “unenlightened” males, but she is very much not alone in this activity. Apparently, tearing down the fragile walls of female self-esteem is extremely lucrative – if you’re a woman. The Daily Mail’s “Femail”, for example, is a veritable breeding-ground for these shallow, scathing and often pointless attacks on women, by women. It’s big business – but why?

According to psychology studies conducted at two universities in Canada last year, women are programmed to behave this way. We’re in competition with other members of the same sex, and often feel threatened by those we perceive as more attractive than ourselves, which invariably leads to hostile behaviour, such as that which abounds in most newspapers and in every women’s magazine on the market. The authors of the studies, T. Vaillancourt and A. Sharma (both female, just so you know), maintain that once we have acknowledged this behaviour we can begin to address it. After all, if we were incapable of breaking our programming and of controlling instinctual behaviour, then rape and paedophilia would be socially acceptable. Saying that women are “born to be bitchy” (thank you, Claudia Connell of the Daily Mail, for that one) is really just an excuse for not trying to improve our behaviour – but I doubt that women like Amy Duncan will ever amend their views based on such silly things as rational arguments, scientific studies and the ideal of behaving decently to their fellow humans.

Oh, I should be sorry for picking on you, Amy – after all, you’re just one of many awful women who seem hell-bent on making the rest of us feel like shit, and singling you out sort of makes me as bad as you, I suppose. I promise, though, you were just the closest example to hand (I did try picking on Liz Jones, but that’s a real minefield there). I mean, come on – you’re condemning Julia Roberts for being “totally unaware of the furore she had created” when people caught sight of her armpit hair, all those years ago. You know why she was “totally unaware”? Because it wasn’t a “furore” to her; it wasn’t even an issue. And to judge by Pixie Lott’s lackadaisical Twitter response to this latest outcry, it isn’t an issue to her either, so your horrified bleating is a bit of a lost cause there as well. I’d love to know why this kind of thing bothers you – and so many other women – so much. Going by the results of Vaillancourt and Sharma’s studies, I would assume you feel threatened by these beautiful celebs, who are so imbued with self-confidence that they can happily attend high-class functions without worrying themselves into a frenzy over whether someone might be judging their armpits. Or perhaps you are genuinely disgusted by body hair on a woman, in which case I would imagine that you’ve been made to feel ashamed of your natural physical state over the years, which again points to low self-esteem. Is this why you’re trying to make other women feel insecure: so you’re not alone?

As someone who has always been just a bit paranoid about her own underarm hair, mostly as a result of knowing that these callow bitches are on the lookout, what surprised me most about the photos of Pixie and Julia was how un-gross a healthy crop of pit fuzz looked alongside a pretty dress. Sure, it was different, but it was also completely natural and entirely their own damn business. It’s emboldened me, pit-wise, I have to say. Certainly less “disgusting” than, say, a red-raw axilla cut almost to the bone by over-shaving, or sporting the red welts that so often come after a wax. I’m not in the habit of elevating pop singers and actresses as role models, but on this occasion these confident, carefree women are leading the way, whereas the venomous proclamations of Amy, Liz and all those other self-haters are just holding us back.

Old Habits Die Hard: Why the Church of England Won’t Support Gay Marriage

The Church of England is an institution with roots reaching far back into British history. It has presided over changes in law, monarchy and societal trends, and it has updated itself (albeit reluctantly) in order to reflect movements in national thought. So why is it digging its heels in so strongly over the proposal to include civil partnerships within the definition of marriage?

As one irreverent wit recently highlighted on Facebook, it is ironic that the Church of England is making a fuss about changes to marriage law when it was itself created by Henry VIII so that he could get a divorce, something that the Catholic Church would not allow him to do. Humour aside, however, and after much research, I think I’ve finally worked out what their problem is – but before I release this particular puppy from its catapult, let’s have a quick review of how I reached my conclusion.

I wasn’t convinced by the line in the papers about how passing this legislation would undermine the Church’s status as principal administrator of State marriages in the UK and alter the meaning of marriage for everybody (with the implication that this would be a bad thing). I really don’t understand how this claim can be substantiated. For one thing, the C of E’s own website states that, in the present day, “more than a quarter of all marriages in England take place before God in the traditional setting of a Church of England church” – I’m just going to assume I’ve misunderstood something fundamental about the definition of State marriages, because “more than a quarter” does not constitute the lion’s share. (If you have a decent explanation for me, please leave a comment.) For another, why would including gay couples in the definition of marriage dilute the meaning of marriage itself?

The Church appears to define marriage as being between a man and a woman because matrimony is first and foremost a precursor to procreation… so why doesn’t it have a problem with elderly hetero couples getting wed for reasons of companionship? They sure as hell aren’t marrying because they want to have kids. And does this mean that infertile couples’ marriages are also invalidated in the eyes of the Church because their union won’t produce offspring? In the Church’s opinion a loving, stable relationship, sanctioned legally through marriage, is the best environment in which to raise a child – those who enter into a civil partnership are making the same level of commitment, so how could this water down the meaning of marriage?

My search for a coherent, reasoned argument – unsurprisingly thwarted by trawling through online media – took me to the Church of England’s own website, where they’ve put up an explanation regarding the Church’s views on civil partnerships and the current proposed changes to “marriage”. Their statement was revealing. While the Church supports civil partnerships – or “friendships”, as the Archbishop of York calls them – it maintains that a “marriage” is traditionally between a man and a woman and that the State has no right to change this – doing so would, in fact, change the definition of “marriage” for everyone. It also maintains that it is arguing for the protection of “marriage” – not just religious marriage but civil marriage as well – and that anyone suggesting that religious marriage be treated separately is failing to acknowledge the Church of England’s established role in providing State-recognised marriages to religious and non-religious couples alike.

This is a pretty weak argument, for several reasons. Firstly, the Church would appear to be advocating the stagnation of British law in order to protect the status quo (primarily for itself, that is, as society needs change in order to remain healthy). I would argue that even the Church, although admittedly long established and still to some extent involved with law-making in the UK, should not have the power to halt the evolution of our legal system just because it doesn’t like the proposed changes. To say that it is trying to protect the definition of both religious and civil marriages actually weakens its position – if separate definitions of religious and civil marriages existed, then to change the definition of civil marriage would in no way affect the definition of marriage for those who might object on religious grounds to the inclusion of same-sex legal partnerships within said definition. And for any married, hetero couples who might object on non-religious grounds, surely the redefining of marriage as “a state into which two people may enter, who love one another and wish to take on the legal responsibilities and benefits that such an arrangement would bring” could draw no objection, as it would be a blanket definition that applies to everyone and would therefore take nothing away from the meaning of a marriage between a man and a woman.

The Church also argues that there is no need to redefine marriage, as civil partnerships provide the same legal rights to same-sex couples as marriages do to straight couples. (I looked this up – they’re virtually identical. There’s some different wording, obviously, but that’s about it.) So, in fact, what we have currently, in our already highly complex legal system, is two ways of saying the same thing – isn’t this a bit pointless? If civil partnerships and marriages provide the same things to couples, and marriages aren’t exclusively religious, and all partnerships are recognised as equal in the eyes of State and Law, why as a society do we need to have one “traditional” and one “modern” definition of love-based partnership?

The Church of England really shot itself in the foot when it allowed gay people to become vicars, as it very publicly and officially put aside the Bible’s argument against homosexuality when it did so. Now bereft of that religiously-sanctioned homophobia, it is forced to come up with weakened, trivialised nonsense in order to try and hang on to marriage as the sole purview of the straight. What the Church now has, in fact, is a percentage of its religious representatives who are forbidden by their own institution to wed! Oh, you’re a gay vicar? That’s progressive; isn’t that cool that you can continue practising your faith without having to deny your sexuality… Oh, but you and your partner have to remain celibate, and your Church won’t let you marry your partner, in the sight of your own God or otherwise, despite your devotion and unshaken belief? That’s… fucking nonsensical, hypocritical, degrading and tragic. What kind of “organised” religion are we dealing with here?!

I think what the Church of England should really be concerned about (and perhaps it is, deep down) is the potential schism looming between those religious organisations that wish to perform marriages for same-sex believers and those that think marriage can only be between a man and a woman. It has, in fact, already garnered a backlash from some of its own vicars for its arguments against the inclusion of same-sex couples in the definition of marriage. Additionally, as the proposed legislation would actively disallow gay marriages in a religious context, the Church is potentially looking at some serious future arguments in the European Court of Human Rights. But as the C of E survived the admission of gay vicars, so I suspect it will survive this, with a mixture of grudging compromise, popularity contest antics and no doubt more embarrassing statements along the way.

So, after my “quick” overview… my conclusion? Rather anticlimactic, I’m afraid: that the Church is afraid of change, paranoid over losing its grip, and confused about what exactly, in the modern day, it really believes.