In April 2016, I was working in Christchurch for a few days. Christchurch is my idea of a very dull town so I spent hours in my hotel room, drawn to the pleasures of two essay collections I’d brought with me: Ben Goldacre’s I think you’ll find it’s a bit more complicated than that (London: Fourth Estate, 2014) and Helen Garner’s Everywhere I look (Melbourne: Text, 2016).

As I moved through these two favourite writers’ selections of their very different work I wondered how my own earlier writing would read today. So I started browsing through it. I found many pieces I’d long forgotten and hoped others would have too. But there were a good few that I was pleased to have written. I began shortlisting those for what has now turned into this selection, thanks to Darlington Press.

I wrote my first academic research paper in 1976 for the Medical Journal of Australia (on psychotropic drug use in the elderly)1 and in 1983, my first opinion piece for a newspaper (on tobacco advertising, published in the Sydney Morning Herald).2 From the very start of my academic career, I was bewildered by the realisation that the vast majority of published research is totally inaccessible to anyone other than other researchers and students in institutions with subscriptions to the often hugely expensive journals in which it appears.

The idea of writing almost exclusively for other researchers instantly struck me as bizarre. In Australia, researchers spend sometimes months drafting and manicuring research grant applications. They then wait another eight months to hear if they were successful in getting the money (in 2015 only 17.6 percent of National Health and Medical Research Council research funding applicants were successful). They then spend three to five years doing the research, and finally waiting more months for their findings to be published in a journal that is highly likely to be pay-walled and therefore accessible only to other researchers. How crazy is it that all this effort would see only a vanishingly small number of fellow researchers ever read it, let alone that its messages and implications so seldom enter into public and political awareness?

This picture would be somewhat rational and understandable in highly technical or arcane research areas where very few outside such fields would have any hope of understanding or interest in them. But health is about all of us. It’s about matters which we think about, act on, avoid, fear, enjoy and above all live with every day of our lives. As we headed toward the 2016 national election, a poll reported that health was the number one issue that voters were concerned about, with 75 percent of voters ranking it “very important”, above “the economy” on 68 percent.3

In universities, there also remain large remnants of the attitude that scientists and researchers should refrain, in the words of one of the four foundational professors at Baltimore’s Johns Hopkins Hospital, Sir William Osler (1849–1919), from “dallying with the Delilah of the press”.4 News media are frequently disdained by academics as trivialising and superficial, something from which those with ambitions of gravitas should keep well away.5

This results in a situation where publicly funded researchers can spend years of their lives developing specialist knowledge about health issues but rarely bring the benefits of that knowledge to forums where individuals and policy makers might pay attention to it and use it to support change.

There is a Niagara of research demonstrating that people get a huge amount of their information and understanding of health issues from the news media. Equally, politicians and their advisors rarely if ever read scholarly papers in research journals. They form their understandings of the issues in their portfolios in a variety of ways. But like us all, they are exposed daily to information and discussion about health and medicine through the news media they consume. Work I did with colleagues in the last few years provided many insights into this.6

I had an instinct about the importance of all this right from the beginning of my research career and so quickly took to trying to get my research covered in the news media and giving high priority to making room in my day to provide media commentary about the areas in which I worked. And here I quickly learned that the constraints on time and space meant that something often richly nuanced and complex needed to be condensed into just two or three sentences in print media reports, or 7.2 seconds in television news.7

When I started making and taking opportunities to write opinion page and occasional feature articles, the access to my work and commentary on controversies in public health rapidly accelerated.

The visibility that this brought opened many doors to senior policy advisors and politicians. I also frequently had the experience of dozens of people at work telling me that they had read and enjoyed a piece I’d written in a newspaper that morning, or a prime-time breakfast radio interview as they got ready for work. Most of these colleagues worked in adjacent specialised areas of public health and would never have read my research work in journals. My own GP and other clinicians I knew often told me that patients had brought in articles of mine they’d cut out of a newspaper to ask about them. This was especially true about pieces I wrote on the risks and benefits of prostate cancer screening (see Chapters 4 and 5). This feedback inspired a book on that issue in 2010.8 We published it as a free ebook and to date it has been downloaded over 34,000 times.

Writers are often starved of information about how widely their work has been read. Journals are increasingly adding readership data to their pages. The Conversation, where I write a column with the same title as this book, is wonderful in that respect, automatically updating readership data ten to 12 times every hour. As of 8 September 2016, my 64 articles for The Conversation have been read 2,493,644 times. Just two of these (reproduced here as Chapters 62 and 63) have been read an astonishing 1,782,660 times, thanks largely to being republished in the massively read I Fucking Love Science blog.9 The other 62 articles have been read 1,039 to 58,283 times (median 4,752).

By contrast, my most read research paper (by far) in my 40-year career has so far had over 147,000 readers (a paper in Injury Prevention, looking at the incidence of gun deaths ten years after the law reforms that followed the 1996 Port Arthur massacre).10 Many have had just a few hundred.

Since that first piece in 1983, I’ve written over 310 opinion-page articles, commentaries and blogs, nearly 70 editorials for journals and 190 letters and news commentaries in research journals on top of my 260 peer-reviewed papers in journals. I wrote a column (“Focus”) for the British Medical Journal for four years (1994–97), and one briefly for the Weekend Australian in 1999 (“Body Parts”) until I was replaced by a writer about sex.

I’ve always loved writing. Early in high school I had the most English of English teachers, Bill “Spring” Lowe. He was firmly old school and wore his chalk-encrusted academic gown in the classroom. He would enter the room, go silently via his highly sprung purposeful walk (hence his nickname) straight to the blackboard, write a sentence and then command that we all parse it in silence in our exercise books. I loved parsing but I loved what he set us for homework even more.

We had to write short essays twice a week. I imagine these were exercises in training us to write grammatically while turning our minds to the joys of creative writing. I never found these a chore, and always looked forward to settling down at the kitchen table that night to write. It’s been pretty much like that ever since.

In 40 years as an academic, I took only eight months of study leave, on both occasions to finish books. I had seven months in Lyon in France in 2006 living 200 metres from the old town near the Saône River and then a perfect month at the Rockefeller Foundation’s Villa Serbelloni in Bellagio on Lake Como in Italy in April 2014, where I had a writer’s fellowship. During both of these I would begin writing after an early breakfast and didn’t stop till about 4 pm. I had no phone to interrupt me and looked at email only once a day. Two books were finished during these retreats (Public health advocacy and tobacco control: making smoking history, published by Blackwell in 2007; and Removing the emperor’s clothes: tobacco plain packaging in Australia, Sydney University Press, 2014).

The experience of these luxurious opportunities to write all day for weeks and months at a time ate away at me when I returned to the University of Sydney, where I had worked for most of my career. I loved academic work, but began to feel increasingly that the many administrative routines, teaching, and research supervision were quietly and obstinately destroying the years of writing pleasure that still remained for me.

So in October 2014, I retired from my position at the university, insofar as academics can ever “retire” (see Chapter 71) and started to write for pleasure nearly every day. In the 20 months since, I’ve published 56 articles and am half way through writing a book on wind-farm health anxieties as a “communicated” disease. I’m also writing a memoir of life in a country town (Bathurst) in the 1950s and 1960s – that one being just for family and close friends.

I write each day overlooking a tranquil Japanese pond we dug in our backyard 20 years ago, watching about 15 mature koi gliding among each other and getting drunk on oxygen under a rock waterfall.

In selecting the 71 pieces for this book, I passed over many that now seem uninteresting, being years away from the news on which they were commenting. These were often commissioned pieces where an editor asked for a quick commentary on a turn in events breaking that day.

I’ve chosen pieces which I hope best illustrate a range of issues that have been important to me across my career. Across the 40 years since my first publication I’ve researched and written in several main areas: tobacco control, gun control, studies of how the news media report on health matters, the practice of public health advocacy, the characteristics of influential public health research and researchers, and the fascinating field of low-risk but high-anxiety modern health panics like mobile phones, wi-fi and particularly wind turbines.

In public health, many challenges focus on trying to animate public and political concern about agents, policies and behaviours that are true threats to health and safety. But there are also a good many examples of the inverse situation as well: where we see people worried and anxious about “threats” that are of low or negligible risk. Here the task is one of trying to reduce that anxiety among the public and to derail it should it gain momentum and start adversely affecting evidence-based policies and people’s lives.

I’ve always been deeply sceptical, and being named Australian Skeptic of the Year in 2013 was one of the most cherished awards I have received. One of my earliest sceptical awakenings was when I began questioning religion, having spent my early youth as both a chorister and an altar boy at the high-Anglican All Saints Cathedral in Bathurst. Years later I wrote about my rapid disillusionment with religion when invited by the British Medical Journal to describe a book that had influenced me (see Chapter 65). Bertrand Russell’s Why I am not a Christian just leapt out when I got the invitation.

Other classics of scepticism I devoured around the same time were Arthur Koestler’s The roots of coincidence (New York: Random House, 1972), Joachim Kahl’s The misery of Christianity (Harmondsworth: Pelican, 1971) and George Orwell’s collected essays and letters – all four volumes of them.

Public health issues provide many opportunities for a sceptical torch to uncover poorly examined assumptions, fragile but entrenched factoids, and the corrupting spell of conflicted interests all coalescing as disciplinary orthodoxy or the dominant ways that issues are talked about.

There are two large slabs of writing in the book about two topics I’ve spent most of my work on: smoking (see Chapters 30–63), and more recently, exposing the bizarre world of opposition to wind farms (Chapters 22–26). There is a paen to the often maligned nanny state, including 150 ways nanny is good for us all (Chapter 17) and an attempt to imagine the dystopia that would unfold if the extremist libertarian senator David Leyonhjelm was taken off the leash (Chapter 18) in his selective contempt for government regulation.

My early career in tobacco control at the end of the 1970s exposed me to daily oceans of tobacco-industry lies and duplicity as they sought to publicly deny the health effects of tobacco, that nicotine was addictive, and that they daily salivated over the prospects of making smoking look as interesting and appealing as possible to children. Privately, they of course knew very differently. I took great delight in publicly pointing out the many contradictions and inconsistencies in what they said in forums when they were speaking to each other. A four-year grant from the United States National Cancer Institute to look through (literally) millions of pages of previously internal, private and sometimes secret tobacco industry documents was probably the most productive phase of my academic career.

While I am often introduced as an anti-smoking “crusader”, I am considered a heretic by some in tobacco control, having spent years challenging certain orthodoxies that some of my colleagues embrace. Each of these is covered by essays in the book. I quickly came to understand that the large majority of people you meet who used to smoke quit by themselves. They didn’t need any drug to help them quit when they smoked their last cigarette. They didn’t go along to a special clinic or therapist and be walked through whatever psychological fashion dominated at the time. In the ten years that electronic cigarettes have been around, far more have quit without vaping (or any aid) than quit with these methods. But you seldom hear about this.

I dropped an early, very pungent stink bomb on this issue in The Lancet in 1985 (Chapter 34) and several more around 20 years later (for example, Chapter 35) when I became fascinated by the resilience of the dogma that it was foolish to try and quit alone when it was clear that that was exactly how most former smokers had done it.

While I don’t like tobacco smoke, what I dislike far more is the abandonment of evidence and ethical principles in the service of a goal. In tobacco control, we see that in the readiness that some have to ban smoking in wide-open outdoor spaces like parks and beaches, where there are near to zero health risks posed to others from drifting smoke (see Chapters 46–48), and the untroubled ease with which some have embraced North Korean-style censorship of films, arguing that movies should have smoking scenes removed or classified as suitable only for adult eyes (Chapters 55 and 56).

Most of the pieces in this selection were originally published as opinion-page articles in newspapers, particularly in the Sydney Morning Herald or, in more recent years, on websites like The Conversation, Crikey and ABC’s recently axed The Drum.

However, I’ve included some that I published as short or sometimes long essays in research journals, most of which are not open access and therefore generally only available to subscribers or those who have access to them through institutional subscriptions, such as university libraries. Some of these papers are long-form essays in which I challenged prevailing dogma in public health, set out the case for a new policy (see Chapter 59) or tried to summarise emerging issues, like e-cigarettes (Chapters 60 and 61).

The selection starts with a reminder that we are all going to die: that death itself cannot be prevented and what considerations ought to follow from that in how we see the main tasks of public health. I end the book with two essays about my parents’ deaths. Early pieces in the book include six on the prostate cancer screening debate, “fashionable” cancers and celebrity involvement in health causes.

When you write pieces that are sceptical or frankly critical of issues which attract impassioned supporters, there is inevitably spirited pushback from those who disagree with you. I’ve been a heavy Twitter user since 2009 and always promote my writing via Twitter. This frequently sees trolling by often anonymous brave souls who believe that anyone with a Twitter account should be obliged to engage with them. Like most sensible people who attract trolling, I have long instantly blocked and muted anyone who, experience tells me, has few if any interests in life other than their obsession. These include gun enthusiasts, anti-vaccination nut-jobs, electrosensitives who are convinced that they are being made ill by electro-magnetic radiation from wi-fi and wireless telephony, wind farm objectors and especially vapers, who make golf, wine and dope bores’ preoccupations look utterly mild. In Chapter 67 I explain why I don’t hesitate to block these (often anonymous) people.

I’m grateful to the publishers of all the pieces in the book for their permission to reprint them. In some cases, and particularly with the selections from The Conversation, permission was not needed as these were covered by Creative Commons agreements where authors very properly retain rights to use their own work as they see fit.

I have left each piece as it was when published, and so have not updated statistics or provided background information about facts, issues and events that may have slipped from some readers’ memories. Where relevant, I have noted any important developments since original publication in the introductions to each piece.

Once again, I need to thank my editor, Agata Mrva-Montoya. This is my fourth book under her light-touch stewardship, and it’s been a total delight. And thank you very much too, Stephanie Chan and Benjamin Fairclough, for your painstaking work in changing all the original hypertexted links to references.

 

Simon Chapman

Sydney, October 2016