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Steve Harrison
DISSECTING ROOM
LIFELINE Steve Harrison Steve Harrison was a builder’s labourer with A levels before working for the Ministry of Labour, a private steel company, and the NHS. His degrees from London, Warwick, and Bristol were squeezed into spare time. He has taught and researched at the University of Leeds since 1978, where he is currently Professor of Health Policy and Politics. He takes up the Chair of Social Policy at the University of Manchester in April 2000. Who was your most influential teacher and why? I am temperamentally resistant to being taught, but Christopher Pollitt (now of Erasmus University) gave me the confidence to make use of what I had learned. Which event has had most effect on your work and why? Being bullied by a senior civil servant who didn’t like what I had written about government policy. I decided that I could write what I liked but that I had better not live up to my income. What would be your advice to a newly qualified doctor? Don’t give all your attention to narrowly clinical matters; the world out there and the opportunities it offers you are changing. How do you relax? I don’t, but I do divert myself from the day job by enthusiastic gigging in several folk bands. What is your greatest regret? Being an incompetent parent to my son (now aged 24 and surviving). What is your favourite play and why? Arthur Miller’s The Crucible. It shows how phenomena that people believe to be real are capable of being real in their effects. What are you currently reading? The Greatest Benefit to Mankind by Roy Porter. What is your worst habit? It’s hard to choose between (a) reading during meals, (b) copying the verbal expressions of my friends, and (c) greasing up to the person I love most. How would you like to die? Without notice.
940
Four weldings and a funeral s a young doctor, I’d learnt to ask patients what they did for a living. “If you know their job and their age” the senior partner always said “then you’re more than halfway to the diagnosis.” Full of wisdom, he’d been. He had also taught me that 1001 was a terrific brand of carpet shampoo. Though he is now long dead, I recall his words every time the cat throws up on the rug. Nobody should die from making a living, but the sad fact is that people do. Over 600 deaths a year are directly related to work in the UK, according to health and safety statistics, and many more get sick or injured. Construction work causes more deaths and serious injuries per worker than almost any other occupation—only mining is more hazardous. I was staggered to learn that in a week-long blitz of 100 scaffolding sites in London, health and safety inspectors issued 50 notices prohibiting further work. Many non-fatal accidents go unreported, perhaps as many as 70%, a Health and Safety Executive review suggests. The self-employed do even worse. They report only 10% or so of the incidents that should be reported. This is where my patient Tom Tiler comes in—actually an electrician, not a tiler. He was 67, while his wife May was embarrassingly (for her) a few years older. Though he was chronically short of breath, it never kept him away from work. He worked for himself, usually alone, and I estimate that, in over 40 years, he had rewired or worked on at least half the local homes I had visited as a family doctor. In the morning Tom always turned up for work with a battered Thermos flask of tea and sandwiches dutifully made for him by May. In the evening, he would return home with the tools of his trade, including the blue overalls, which May would then put in the wash.
A
Tom’s breathlessness was unchanged until just after he retired. It was when his chest radiograph came back that I first mentioned the ‘A’ word. He shrugged. Of course there was asbestos in some homes. He may not have known that it is the only mineral occurring naturally as a fibre, or that the word comes from the Greek for “unquenchable”, but he was vaguely aware it was dangerous. I doubt he realised that deaths from asbestos-related diseases (mostly mesothelioma) were running at nearly 3000 a year. I had not known myself till then that the death toll was actually increasing year on year, thanks to the long latent period of 15 years or more of mesothelioma. There is still lots of asbestos in buildings as boarding, insulation, and even in plaster, so deaths are predicted to rise to between 5000 and 10 000 deaths a year, peaking some time around 2010. In the light of this, perhaps I should be asking workers like Tom how they deal with asbestos when they come across it. Do they keep it damp and use hand-tools to minimise dust when cutting through it? As a family doctor I could also ask if they ever use a mask, what methods they have for hoovering up asbestos, and whether they know where to get more information to protect themselves and their families. It would have surprised me if Tom had ever double-bagged asbestos waste and dealt with it according to regulations, especially as he was self-employed. It is now pointless, and too late, to warn Tom that he should have taken strict precautions, or told him to wash his hands before having a cup of tea and his lunch. But what should I have said? And what do I now tell his widow about the threat that was in her laundry basket? Carol Cooper
THE LANCET • Vol 355 • March 11, 2000
LIFELINE Steve Harrison Steve Harrison was a builder’s labourer with A levels before working for the Ministry of Labour, a private steel company, and the NHS. His degrees from London, Warwick, and Bristol were squeezed into spare time. He has taught and researched at the University of Leeds since 1978, where he is currently Professor of Health Policy and Politics. He takes up the Chair of Social Policy at the University of Manchester in April 2000. Who was your most influential teacher and why? I am temperamentally resistant to being taught, but Christopher Pollitt (now of Erasmus University) gave me the confidence to make use of what I had learned. Which event has had most effect on your work and why? Being bullied by a senior civil servant who didn’t like what I had written about government policy. I decided that I could write what I liked but that I had better not live up to my income. What would be your advice to a newly qualified doctor? Don’t give all your attention to narrowly clinical matters; the world out there and the opportunities it offers you are changing. How do you relax? I don’t, but I do divert myself from the day job by enthusiastic gigging in several folk bands. What is your greatest regret? Being an incompetent parent to my son (now aged 24 and surviving). What is your favourite play and why? Arthur Miller’s The Crucible. It shows how phenomena that people believe to be real are capable of being real in their effects. What are you currently reading? The Greatest Benefit to Mankind by Roy Porter. What is your worst habit? It’s hard to choose between (a) reading during meals, (b) copying the verbal expressions of my friends, and (c) greasing up to the person I love most. How would you like to die? Without notice.
940
Four weldings and a funeral s a young doctor, I’d learnt to ask patients what they did for a living. “If you know their job and their age” the senior partner always said “then you’re more than halfway to the diagnosis.” Full of wisdom, he’d been. He had also taught me that 1001 was a terrific brand of carpet shampoo. Though he is now long dead, I recall his words every time the cat throws up on the rug. Nobody should die from making a living, but the sad fact is that people do. Over 600 deaths a year are directly related to work in the UK, according to health and safety statistics, and many more get sick or injured. Construction work causes more deaths and serious injuries per worker than almost any other occupation—only mining is more hazardous. I was staggered to learn that in a week-long blitz of 100 scaffolding sites in London, health and safety inspectors issued 50 notices prohibiting further work. Many non-fatal accidents go unreported, perhaps as many as 70%, a Health and Safety Executive review suggests. The self-employed do even worse. They report only 10% or so of the incidents that should be reported. This is where my patient Tom Tiler comes in—actually an electrician, not a tiler. He was 67, while his wife May was embarrassingly (for her) a few years older. Though he was chronically short of breath, it never kept him away from work. He worked for himself, usually alone, and I estimate that, in over 40 years, he had rewired or worked on at least half the local homes I had visited as a family doctor. In the morning Tom always turned up for work with a battered Thermos flask of tea and sandwiches dutifully made for him by May. In the evening, he would return home with the tools of his trade, including the blue overalls, which May would then put in the wash.
A
Tom’s breathlessness was unchanged until just after he retired. It was when his chest radiograph came back that I first mentioned the ‘A’ word. He shrugged. Of course there was asbestos in some homes. He may not have known that it is the only mineral occurring naturally as a fibre, or that the word comes from the Greek for “unquenchable”, but he was vaguely aware it was dangerous. I doubt he realised that deaths from asbestos-related diseases (mostly mesothelioma) were running at nearly 3000 a year. I had not known myself till then that the death toll was actually increasing year on year, thanks to the long latent period of 15 years or more of mesothelioma. There is still lots of asbestos in buildings as boarding, insulation, and even in plaster, so deaths are predicted to rise to between 5000 and 10 000 deaths a year, peaking some time around 2010. In the light of this, perhaps I should be asking workers like Tom how they deal with asbestos when they come across it. Do they keep it damp and use hand-tools to minimise dust when cutting through it? As a family doctor I could also ask if they ever use a mask, what methods they have for hoovering up asbestos, and whether they know where to get more information to protect themselves and their families. It would have surprised me if Tom had ever double-bagged asbestos waste and dealt with it according to regulations, especially as he was self-employed. It is now pointless, and too late, to warn Tom that he should have taken strict precautions, or told him to wash his hands before having a cup of tea and his lunch. But what should I have said? And what do I now tell his widow about the threat that was in her laundry basket? Carol Cooper
THE LANCET • Vol 355 • March 11, 2000