R4

Two weeks ago, Camden Council gave planning permission for the R4 complex of housing to be built on the King's Cross Central site. The block will serve a mixture of uses - 15 flats of supported housing for people with mental health problems, 77 units of "affordable" housing to rent, and 25 flats for shared-ownership. The Homes & Community Agency has funded it, via a £42m grant to One Housing Group (for more on HCA grants, see here).

This is what it will look like:



The Kings Cross Development Forum's views on the plans can be found here.

We visited the plot (on the junction of York Way and Rufford Street) yesterday, on the eastern fringe of the brownfield site. A security guard was drinking coffee and talking into a mobile phone on the roof of a huge prefab. Over the bulldozers and containers in the forecourt, he looked onto a vast field, scuffed with weeds, leading up a steep verge to the Eurostar line, as it edges east.



For him, every day must feel like Groundhog Day. Guarding this hugely ambitious development project must have seemed rather thrilling once, but aside from the R4 scheme and some completed student accommodation, there are no immediate plans to build on this land.

A letter in the local press reveals that Argent - the developers of the KXC site - cannot afford to build the earmarked office blocks until corporate tenants (in particular, Sainsbury's) have confirmed their lets. The writer points out that several million square feet of office space in the City, snapped up by corporate backers in happier financial times, has not been built on. With this in mind, is it possible that the King's Cross will not see the sort of corporate activity it once promised? And if so, could the land be put to better use?

If not, what of the residents of R4? The letter-writer offers a bleak prediction:

These two schemes are paid for by taxpayers’ money. While the developers wait for corporate occupiers and the investors that they attract, problems for local people and commuters from the surrounding areas are compounded by the closure of the remains of Battlebridge Road ... The students and the residents of the blocks of social housing flats to be built facing on to York Way may find themselves looking at one another across an otherwise deserted site.

COMPULSORY VOTING

At the time of a General Election, somebody usually asks, "wouldn't it be good if it was made compulsory for everybody eligible to vote in the UK to do so?" It has been the subject of a recent forum on the BBC, to which there was a mixed response.

Compulsory voting would be a bad and undemocratic idea for four reasons.

First and foremost, ballot box refuseniks do not vote either because they cannot be bothered, because they do not know or care anything about politics or political parties, because they oppose what all the parties stand for, or because they are practically unable to vote. If voting became compulsory, apathy, ignorance, opposition and incapacity would not suddenly vanish. Anybody in the first three categories would be forecefully marched down to the polling station, and made to vote for a party they didn't know about, didn't care about, or hated. They may spoil their paper or, more likely, they would vote at random. This would seriously distort the results arising from considered, deliberate and enthusiastic votes.

Secondly, it is democratically useful to know when a government has been elected with a small number of votes. In 2005, Blair was elected by a smaller proportion of the eligible electorate than any Prime Minister in recent history. However much he ducked the issue, Parliament and the electorate could not ignore the apathy and/or opposition to the government. If we know that few people are voting, there is at least a possibility of doing something about it.

Thirdly, voting in an election is not the only form of democratic activity. Signing petitions, campaigning, going on strike, protesting (and counter-protesting) - all are ways of registering opinion. If voting was made compulsory, consideration would have to be given to mandating these activities too.

Fourthly, compulsory voting is profoundly undemocratic in a First Past the Post system. Some of the opinion polls this week suggest that the Lib Dems could win the highest proportion of the vote,yet be the smallest party in the Commons, and that Labour could come third in the percentages and be the largest party in the House. Each vote does not carry an equal value - compulsory voting would only compound this.

I shall write about something other than the General Election soon - promise.

PROBABLY OVER

"I think New Labour is probably over." - Tony Benn

Tony Wood passes scathing judgement upon New Labour in the latest issue of the New Left Review. Much of what he writes is well-known, especially among those unbedazzled by the superficial sheen of the late 90s and early 00s, but its aggregation of dogmatic neoliberalism, irresponsibility and unashamed venality confirms the last 13 years as the most right-wing period of British governance in living (or dying) memory.

A few facts stand out. Firstly, Blair's liberal interventionism was a sham from the start: he began his first-term by selling weapons to Suharto and giving effusive support for Putin's violent campaign in Chechnya, not to mention the military assault in Kosovo. After 9/11, Blair became a pioneer of the invasions of Afghanistan and Iraq. Far from being Bush's poodle, without his recruitment of new Allies, the invasions would have proved diplomatically unviable.

The consequences of this in the Middle East are well-known, but in the UK, too, his hawkishness cost lives and liberty. In July 2005, 52 people died at the hands of suicide bombers motivated by revenge for Blair's Middle Eastern adventures. Responding to this amplified terror threat, Parliament agreed that terror suspects could be held without charge for 28 days, compared to 2 days in the US and Germany (the Commons originally agreed an extension to 42 days, before the Lords overturned it).

The result of New Labour's economic policies is also well known to us. Despite the introduction of a minimum wage, the ratio of wages to GDP fell under New Labour. It failed to reverse the Tories' anti-union laws, and further deregulated corporate and financial life, with the result that capital dominated over labour more than it had ever done during the 1980s. The share of finance grew from 22% to 32% of GDP between 1990 and 2007, and manufacturing has fallen from 20% to 12% of GDP since 1997 (a much higher rate of decline than under the Tories).

The result of this - aside from mortgage defaults, soaring unemployment and public spending cuts (now seen as an unavoidable response to Britain's deficit, itself a result of the £1.4 trillion bail-out of the banks) has been a widening of inequality.

In 1997, the richest 1% of Britain's owned 17% of the country's wealth; now they own 21% (the poorest 50%, meanwhile, owns just 6%). In 1997, the richest 1% of the population received 8% of total income; now they enjoy 12.6%. In 2009, profits rose by £24 billion, whilst wages increased by only £2 billion. And nearly 2.5 people are now unemployed, many receiving just £7.28 per day in benefits.

Even Labour's biggest boast - that it has improved public services via increased investment - does not stand up to scrutiny. Public expenditure on the NHS increased by an average of 7% during the last decade, yet there are 13,000 fewer acute hospital beds now than in 1997, hygiene standards have deteriorated and readmission rates have increased (the flipside to a reduction in waiting times).

Labour has invested in management and passed money to the private-sector - only a small percentage has been spent on clinical care. It has championed PFI projects (a blatant and expensive handover of capital to private consortia), outsourcing and the internal market. The latter requires an impenetrable bureaucratic structure, and a relentless succession of top-down targets which compromise clinicians' ability to do their jobs. It is difficult to think of an area of public life in which Labour has wasted more money than the NHS.

Wood does not mention housing policy, but here again Labour's record is woeful. Social housing waiting lists have risen by by around 70% since 1997 (and have nearly quadrupled in some cities), yet Labour has refused to build new Council houses, and has actively encouraged Councils to sell their stock to pay for Decent Homes repairs. Owen Hatherley describes a programme of, if you will, urban disaster capitalism: the Pathfinder scheme, which allows compulsory purchase and demolition of housing which has no market potential, and replaces it with housing aimed at "the aspirational classes".

Owen Hatherley describes the bail-out of Housing Associations and the building industry here. The Homes and Communities Agency - one of Labour's many quangos - handed £2.68 billion to private builders in early 2009, of which 50% simply recapitalised struggling volume builders. The remaining 50% has been spent on developments which will deliver around 5,000 homes to buy and 10,000 for "affordable rent".

Intended to stimulate the only industry still capable of keeping the economy going, its public benefit is neglible, and may even be negative. "At the very end of the New Labour project," says Hatherley, "we find a massive programme of public funding for substandard private housing."

None of this is a rationale for voting for either of Labour's opponents, but it is a reminder that, in the absence of desirable alternatives, a vote for Labour remains a vote for a more unequal Britain.

SOUND AND FURY

Yesterday, Gordon Brown stood outside 10 Downing Street with his cabinet and announced that a General Election will be held on 6 May. He reminded his audience of the pledge - supported by the Tories - to halve the deficit within the next four years. Alongside this issue, all others sink into relevance.

John Lanchester, writing in the LRB, has spelled out what this is likely to mean. If the Treasury's forecast of 2.75% growth is correct, the cuts required during the next Parliament correspond to 11% of public spending. If the government agrees to protect frontline health and education services and international development, other departments will need to cut 16% of their funding. According to the Institute of Fiscal Studies, this would equate to liquidating the army, withholding one third of the Government's annual grant to Network Rail, the closure of most courts and 50% of prisons, and a savage bludgeoning of welfare benefits and social care services.

If, as many economists believe, the Treasury's estimates are overly optimistic and Barclays' forecast of 1.75% growth is nearer the mark, the Government will have to find a further £66bn over and above the £57bn cuts already announced by Alastair Darling. This makes Thatcher's cuts - which merely reduced many areas of public spending to zero growth - or even the cuts imposed by Callaghan and Healey after the IMF bail-out pale into insignificance. Cuts of this magnitude will be unacceptable to the public, and virtually impossible for a government with a slim majority to force through.

Nevertheless, the government (and the public) will be held to ransom by the international bond markets. They will accept nothing less than draconian public spending cuts, and will not tolerate increases in inflation (which would wipe out the value of the deficit - good for the country's bank balance, but bad for the markets which hold and trade in government debt).

The government - whether Labour, Tory or coalition - fears the reaction of the markets far more than that of Unions or the general public. More than at any time in my life, our current situation exposes the sham of parliamentary democracy. Neither the markets nor the banks will mind too much who wins the election, because they know that they can dictate the financial agenda. To paraphrase the old graffito from the 70s, "Vote John Varley - cut out the middle-man."

As the resurgent Keynesians tell us, the most pressing question occupying the minds of the new Chancellor will be (a) when the first cuts should materialise, (b) how much should be cut, and (c) how high inflation can go without sparking a buyers' strike in securities. If services are cut too quickly, the economy could relapse into recession, pushing asset prices down further and, hence, pushing up debt; if they are cut too slowly, the markets will stop trading. If they are too draconian, there will be a risk of mass public disorder and industrial action. Lanchester predicts that any new government will increase VAT, reset inflation to 4% (which must also mean an increase in interest rates), and ratchet up public spending cuts in April 2011. The scale of those cuts is still too extreme to countenance.

As an aside, it seems that the more hollow the contest, the more exciting the spectacle. Watching the election coverage on May 6th and 7th will be rather like (forgive me...) watching Bangladesh chasing 300 on a flat pitch in the second innings of a 50-over match against Zimbabwe. Both teams are hopeless, you don't really care about or take seriously either side - but somehow there is a thrill in the chase. I also anticipate that I will suspend much reason and rationality and be surprisingly tribal on the night (though, of course, I won't actually vote for Labour).

I also expect a half-hearted campaign from both Labour and the Tories. After all, who would want to win this election? Whoever wins it will surely lose the next general election. By then, the political complexion of the country will have changed (though the pain will barely have eased). Whether we will find socialism or slip into barbarism, nobody can say. We sure as hell won't find out during this election campaign.

EVIDENCE-BASED HEALTH SCIENCE: DOUBLEPLUSUNGOOD

I am no homeopathy sympathiser, but the parameters of the recent debate about whether it should receive public funding have been depressingly narrow, not to mention bullying. The winning argument was that homeopathy is no more effective at treating particular complaints than a placebo. The lack of an "evidence-base" led health scientists to denounce homeopathy as no more than new-age quackery.

The reputation of homeopathy will not have helped its cause. It represents everything that the dominant philosophy of health science opposes: it is subjective, where health science is objective. It fails miserably in the laboratory, though even its fiercest critics acknowledge that many people have felt healthier after using it.

So we have here a paradox. It seems reasonable that we should not pay for something for which there is no evidence; and yet homeopathy does appear to work for many people. What, therefore, does one mean by "evidence"? Can "blind faith" in medicine ever be scientific? What is the nature of truth in this kind of debate?

In 1993, the Cochrane Collaborative developed a database to bring together research which demonstrated the effectiveness of particular interventions. Research is eligible for inclusion if it is based on randomised-controlled trials (RCTs); any other form of enquiry - e.g. empirical or naturalistic research using real patients in the clinic - is excluded.

I have written before about the distorting effects of RCTs. In order to test something objectively, external factors (such as the quality of the clinician, any co-morbidities which the patient might present, genetic predispositions etc) must be removed. For example: to test whether a particular psychotherapy is effective in treating depression in comparison to, say, an antidepressant, all research subjects must be as identical as possible. Everybody must have similar levels of depression, nobody can have panic disorder, because their panicky symptoms might warp the trial. The research also must not allow any form of relationship to develop between the patient and their therapist or doctor, as this might also compromise the objectivity of the trial. The problem is, something like 50% of people with clinical depression also have other neurotic disorders (and all will come into contact with a medical professional).

The evidence-based health science (EBHS) movement has no truck with this. The RCT has become the gold standard of research, to the exclusion of other approaches. "In the starkest terms," explain the authors of this deconstructive critique of EBHS, "we are currently witnessing the health sciences engaged in a strange process of eliminating some ways of knowing."

The hegemony of EBHS has also sterilised debate in health science:

an unvarying, uniform language – an ossifying discourse – is being mandated in a number of faculties of health sciences where the dominant paradigm of EBHS has achieved hegemony. This makes it difficult for scholars to express new and different ideas in an intellectual circle where normalisation and standardisation are privileged in the development of knowledge.

In recent years, the National Institute of Health and Clinical Excellence (NICE) has, on the basis of RCT research, recommended variants of Cognitive Behavioural Therapy (CBT) for virtually all neurotic disorders, and disregarded other therapies which are less amenable to RCTs. But rather than arguing their case within different parameters of debate, psychoanalysts have agreed to test their approach via RCTs. If this allows a broader choice of therapies to be available on the NHS, it must be welcome (though one wonders if the RCTs do not find psychoanalysis to be effective, whether psychoanalysts will all retain as Cognitive Behavioural Therapists...).

Such are the confines of positivism. Truth is alienated from subjectivity; it is "out there," independent of the observer, waiting to be grasped, an eternal aggregate of a priori facts which cannot be remoulded by new events. The word used by the deconstructionists - "ossified" - is spot on, and although at times they do not care to admit it, theirs is a materialist critique, in that it admits that ideas and abstractions must derive from lived experience.

This applies to EBHS itself. It is a political doctrine which believes - in the words of Hannah Arendt - that it "can explain everything and every occurrence by deducing it from a single premise." Because that single premise is "out there" and objective, it needs a different language to describe it. Here the deconstructionists recall the Orwellian language of Newspeak. Language is reduced to its most monochromatic basic units; synonyms are eradicated, and what's left behind is radically redefined. In EBHS, "evidence" is the only word used to describe exercises which demonstrate medical effectiveness, yet "evidence" only means "RCT." In other words, naturalistic clinical trials which show that an intervention works cannot be classified as evidence which, so the logic goes, means the intervention cannot be effective.

This is lazy, paradoxical thinking:

The mastery of scientific Newspeak is, for the most part, a regurgitation of prefabricated formulas (buzz words or catch words) that is informed by a single, powerful lexicon. This new guide book of scientific vocabulary, including terms connected with evidence-based medicine (e.g. systematic literature review, knowledge transfer, best practices, champions, etc.), is taken seriously in the realm of health sciences, so much so that it is considered vital as a reflection of ‘real science’.

The British Government's rhetoric of evidence-based healthcare and "patient choice" (themselves often contradictory) will increasingly be compromised by brutally-cut health budgets. The stories about people with dementia who are denied certain cholinesterase inhibitors because they are too expensive will begin to be replicated amongst people with non-terminal illnesses too. But just as in hard times the conventional economic wisdom of applied mathematics is supplanted by the subjective experience of people on the dole or striking to protect their wages, so patients can fight the doctrinaire ideas of the EBHS movement with a demand that their opinions about what might help them get better may be just as relevant as the opinions of their doctor.

"Plurality," says Hannah Arendt, "is the condition of human action because we are all the same, that is, human, in such a way that nobody is ever the same as anyone else who ever lived, lives, or will live." Such pluralism is constantly under threat in a capitalist society, which seeks to reduce us to consumers (even of healthcare). But when that capitalist society becomes vulnerable, there is suddenly the space for individual voices to be heard, and for the collective voice to win through. Not the collective voice of the objective, the abstract or the mean, but of "an honest plurality of voices [which] will open up a space of freedom for the radical singularity of individual and disparate knowledge."