Tag Archives: politics

Tuareg tales and the R word

The first pod story of 2011 comes from Mali, where a group of people are trying to use storytelling to preserve the Tamasheq language. The language is spoken by a dwindling number of the nomadic Tuareg people.

That’s followed by a conversation about the merits of the King James Bible, which turns 400 in 2011. In secular Britain, those merits aren’t strictly religious. In fact, people like former UK poet laureate Andrew Motion view the King James Bible as a literary giant, second only perhaps to Shakespeare. He argues that we are fast forgetting how it has shaped English-language poetry, fiction and rhetoric.

Then, the main event: the R word.  Or perhaps the R-rated word: rationing. For manyAmericans, the idea of rationing is, well, unAmerican. In Britain though, rationing is part of the national psyche: it got the country through two world wars, and its collectivist values are at the core of Britain’s government-run health service. Now though, the emergence of expensive, new end-of-life drugs are challenging Brits’ belief in rationing.

During World War II and for nine years after, the British government rationed most food items: meat, flour, eggs, sugar. The government also strictly controlled the supply of gasoline, soap, stockings—even the number of buttons on jackets.

Although there was wartime rationing elsewhere, including in the United States, it generally applied to fewer items over fewer years and was quickly forgotten. In Britain, however, rationing became a part of the national identity.

Many older Britons speak of rationing as a great legacy of those wartime and post-war years, when people sacrificed their own interests for the greater good.

After World War II, the British government extended this societal approach to health care. It created the National Health Service, the NHS.

Today, 95 percent of Britons get their care through the government-run program. In order to provide care to everyone, the government says it must place limits on the care it provides. It must ration.

Limits to Care

“We have a limited budget for health care, voted by Parliament every year, and we have to live within our means,” said Michael Rawlins, chairman of a government agency called the National Institute for Health and Clinical Excellence (NICE).

NICE decides which drugs and other treatments can be prescribed by NHS doctors.

NICE was created in 1999 to clarify the reasons why certain drugs are approved and others are rejected. “In the old days it used to be done in secret, behind closed doors, in smoke-filled rooms,” Rawlins said. “Now it’s explicit. Everybody knows what the rules are.”

NICE’s rationing decisions start with a basic premise: The government should spend its limited resources on treatments that do the most good for the money. NICE calculates cost-effectiveness with a widely used measure called a quality-adjusted life year (QALY).

In essence, NICE asks these questions: How much does a drug or procedure cost? How much does the treatment extend the average patient’s life? And what is the quality of that life gained?

The calculations are complicated, but imagine that a cancer treatment costs $100,000 and that it extends the life of the average patient by four years. That means the cost of the treatment per year gained is $25,000.

Now imagine that for part of those four years the patient will be in pain and bedridden. NICE might figure the quality of that life at 50 percent of perfect health. Under NICE’s formula, that would make the drug half as cost-effective. In other words, the result would be $50,000 per quality-adjusted year gained.

NICE has set a maximum that it will spend on a treatment: about $47,000 per quality-adjusted year gained.

NICE tends to assume, without always performing calculations, that most common treatments are cost effective—including insulin for diabetes, cholesterol-lowering drugs for heart disease, and kidney transplants.

Instead, NICE analyzes only selected therapies, such as expensive new drugs that may extend life at the end of life. It has calculated that some of the more expensive drugs meant to slow the progression of Alzheimer’s Disease and some cancers fall below the cost-effectiveness threshold. In such cases, NICE says, the NHS shouldn’t pay for the drugs.

NICE chairman Michael Rawlins acknowledged that his agency’s decisions deprive some patients of drugs that may extend their lives by several months or more.

“We do recognize that the end of life is a very special time,” Rawlins said. “[It] allows people to attend weddings, see a grandchild born, seek forgivenesses.”

But he argued that if Britain spends a lot of money at the end of life, “we’re going to have to deprive other people of cost-effective care.” Rawlins said that might mean spending less money at the beginning of life—and might result in a higher infant mortality rate.

A Cancer Patient Fights Back

“Imagine how I feel when I hear people saying that if they give me the drugs I need to stay alive, babies are dying,” said David Cook, one of a growing number of British cancer patients speaking out against NICE and its rationing formula.

While sipping strong English tea in his village farmhouse kitchen, Cook argued that NICE’s logic breaks down when you go from the abstract formula to specific patients—like him.

A senior government manager in his fifties, Cook was diagnosed with kidney cancer in 2004. Two years later his prognosis was bad.

Cook’s doctor said he would die within months unless he got a drug to slow the growth of his tumors. But the cost of the drug was high—too high for NICE in light of the advanced stage of Cook’s cancer—and the NHS refused to pay for it.

Cook fought back. He contended that NICE’s rationing formula calculates cost-effectiveness based on the average patient, but individual patients might do better on a given treatment, which would make the drug more cost effective than NICE suggests. Cook’s doctor believed that was true for him, so Cook pleaded his case before a panel of experts.

“I had to persuade a total of six people that were in the room” he said. “I had to talk for my life.” Cook won his appeal—he got the drug—but he resented that he had to fight for it, that he was treated as an exception.

Cook has other complaints about NICE.

He says the agency treats patients inequitably; it is more likely to reject drugs for rarer cancers like his because the treatments are more expensive than those, say, for breast cancer or lung cancer. “We’re being penalized for having…the ‘wrong’ type of cancer,” he said.

Cook contends that NICE overreaches by measuring the quality of a patient’s life. He said it should not be up to bureaucrats to decide that the life of a bedridden patient, for instance, is worth a quarter or a half that of someone in perfect health.

Cook further argues that NICE neglects an important fact—that by helping a patient live longer, a drug may improve not only that patient’s life but also the lives of loved ones. For his part, Cook remains active and working and has helped care for his wife, who has been diagnosed with breast cancer.

Public Backlash

Stories like David Cook’s—about the government restricting access to life-saving drugs—have become common in the British media.

Part of the reason is that many new cancer drugs have become available in the last few years, and some of these drugs are extremely expensive.

NICE’s rejection of such drugs has fueled a growing backlash against the agency. Patient groups and drug companies have called it heartless and indiscriminate.

NICE’s future now hangs in the balance.

In May 2010, Britain’s ruling Labour Party, which founded the agency, lost a general election. The new Conservative-led government has said it will establish a cancer fund, totaling more than $300 million a year, to pay for some cancer drugs turned down by NICE.

This comes at a time of economic crisis in Britain. The government is making large cuts in just about every other public service.

Health economist Alan Maynard of the University of York said it may seem compassionate to set up a cancer fund, but it undermines NICE at a time when the country needs to be reminded of the value of rationing.

These days in Britain, few speak favorably about an agency that was set up to ensure that the government could provide the best care to the most people.

“NICE is not very popular,” said writer Lionel Shriver. “I may be the only fan of NICE in the country. After all, it’s the organization that says ‘no.’”

Shriver is an American who lives in London. Her latest novel, So Much for That, is about the U.S. health care system and how, in her view, it failed a woman who was dying of cancer.  Shriver said her novel would have turned out “drastically differently” if she’d been writing about the British health care system.

The novel follows a character who has mesothelioma, a rare but deadly disease that is usually caused by exposure to asbestos. The character is partially based on a close friend of Shriver’s who lived 15 months after being diagnosed with mesothelioma. Shriver says her friend’s treatment cost $2 million.

“If she had been in the UK, that character would have been given palliative care alone,” said Shriver. “They would have tried to keep her comfortable and out of pain, but they would have skipped the major surgery. They would have skipped all that excruciating chemotherapy.”

“I think that my character and indeed my friend would have been better off in the United Kingdom,” Shriver said.

A Model for Other Countries?

Britain’s medical rationing has been noticed around the world. A steady stream of health officials from countries like Brazil, China, and Poland have visited NICE to see if setting up a rationing agency along similar lines makes sense for them.

Some American health care experts wanted to establish an agency like NICE as part of reforming the U.S. health care system. But after Sarah Palin cited Britain as the inspiration for what she claimed was an Obama Administration plan for “death panels,” that idea was dropped.

In fact, in this year’s health care reform law, Congress specifically prohibited British-style rationing. Medicare, for example, cannot apply quality-of-life tests in determining the cost-effectiveness of treatments.

Lionel Shiver is not pleased with that outcome. She said Americans still don’t seem ready to focus on some key end-of-life questions. “At least in the UK we’re having the conversation. How much is a life worth? And what kind of quality of life is that?”

But as other countries look to Britain as a model, it’s far from clear that the model itself will survive.

And that begs the question: Can explicit health care rationing work anywhere if it’s in trouble in the very country that may be best equipped to take it on?

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English sources, Italian renaissance, Spanish rebellion

The online version of the Oxford English Dictionary has just had a makeover. One of the new features is a list of 1,000 sources for English words and expressions. These tend to be authors  (Shakespeare, Dickens, Twain) or publications (Chambers’s Cyclopaedia, Geographical Journal, New York Times). This is a historical list; there is no room for, to name but one modern linguistic innovator, André 3000.

My favorite entries are for people or publications I haven’t heard of: Helkiah Crooke — what a name!– a 17th century physician and anatomist; Anne Baker, a 19th century philologist; the Dictionary of the Older Scottish Tongue.

With budgets tight at American schools and colleges, and with a growing interest in Chinese, what happens to a language like Italian?

Once a heritage language, Italian is now more of a lifestyle choice. At Eataly — a new food emporium in New York City — TV chef Lidia Bastianich offers cooking and language classes. A latte just tastes better when you can order it in the original language, or so the thinking goes. Meantime, Italian has been canceled at SUNY-Albany, and appears imperiled elsewhere, at colleges and grade schools. It’s only through the rearguard action of people like Margaret Cuomo of the Italian Language Foundation that the language is still studied in the United States.

Also in the pod this week: Latin America is livid with the Royal Spanish Academy. That’s nothing new — there’s always been tension over how Spanish should, if at all, be regulated. But now, the academy wants to reduce the alphabet from 29 to 27 letters. The victims are a couple of couples: ch and ll, both beloved in the Americas. These sounds — or spellings — aren’t disappearing. They just will no longer have their special place in the dictionary. Those dictionary publishers will no doubt put out new editions, which will help their bottom line: they must love the Royal Spanish Academy!

Venezuela’s Hugo Chávez must like the academy too: it’s given him something else to rail about. Now that ch is no longer recognized, he has proclaimed that he will henceforward be referred to Ávez. Sounds kind of cockney.

Helping us wade through the inter-Spanish linguistic warfare is Ilan Stavans, author of Spanglish, the Making of the New American Language. Listen to an interview with him on that subject here.

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The events of English and the future of Tibetan

Five language stories from the past month with Patrick, Carol and Rhitu

5.Tibetan in schools

Tibetans have been protesting over the potential loss of their language in schools.

It started after the Chinese Communist Party’s Qinghai province chief, Qiang Wei reportedly called for “a common language” in schools.  He went on to propose that Qinghai use Mandarin as the language of instruction in all schools. Now,  it already is the language of instruction in most schools in Qinghai, as in the rest of China. But the province is also home to a significant number of Tibetans, who typically learn at elementary level in their own language. Those who stay on in higher grades switch to Mandarin.

Estimates put the number of protesters between several hundred and several thousand. They spread beyond Tibetan speakers, with Uigher-speaking students also taking to the streets in sympathy. They know they could be next.

4. Spain re-orders its family names

The Spanish government has drafted a law that would change birth registration rules. That could result in a dramatic transformation of naming customs. Spaniards have two family names.  Right now, either of those names can come first, though it’s customary for the father’s name to assume priority. Under the proposed law, the two names would simply be listed alphabetically, unless otherwise instructed by the parents. This may well result in gender neutrality, but it would certainly discriminate against letters at the end of the alphabet. Zapatero? Forgetaboutit! Just think: had the law been around in 1892, Spanish dictator Francisco Franco might have been known as Generalísimo Bahamonde. Would he have won the Spanish Civil War with a name like that?

3. Events that shaped English

A non-profit group in Britain called The English Project is putting together a list of historical events and places that have shaped the development of the English language. It’s a thoroughly UK-centric list. Which is fair enough, until that time in history when Britain began exporting the English language. Here’s the list.  Post your ideas for a more expansive global list on English either there or on this site.

2.When can you say you speak a language? There’s no widely-accepted standard for speaking a second language, nor should there be: people use languages in so many different ways that there can never be  a single answer to this question.  But it’s instructive to try to come up with your own definition.

For the writer of this Economist blog, it’s a test of linguistic skills in journalism: “If my editor sent me to a country where I needed to report on a topic of general interest for The Economist, could I pull off interviews and research?  If yes, I speak it.”

The comments after the blog post are all over the map, as they should be:  “When you find yourself dreaming in a language, you can safely say that you can speak it.” (I disagree: I dream more fluently than I speak).  I prefer this one: “When you have mastered all, I emphasize all, the nuances contained in a given cuss word, and know when and when not, to deploy the word, so that you obtain the precise effect you want, not more, not less. This you do a native speaker of the language.”

1. We speak, therefore we think. New research out of Australia on how the languages we speak may determine how we think. Pormpuraawans — aboriginals living in a remote part of Australia — relate spatially to things according to the position of the sun. So while they think east and west, we English speakers often think left and right,  Arabic and Hebrew speaker right and left, and Chinese speakers up and down.  This plays in nicely to the recently renewed debate over language and thought: does language arise out of thought, or does it give shape to thought? Are we all prisoners of our native tongues?

Musings on this here and here. And more coverage of the research in a recent World Science podcast.

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Supermarket French, Chanson French, and Arabic in repose

The French of Anna Sam and that of Juliette Gréco could hardly be more different.

The French of Gréco (pictured) is moody and melodramatic, as befits this veteran chanteuse. Her pitch swoops to low octave depths and her Rs rrrrroll,  as she sings of love, betrayal and Paris. The songs sound like personal confessions, but most are not:  she became famous by singing the poems and lyrics of Raymond Queneau, Jacques Prévert and others. Now in her 80s, Gréco is bringing her über-Frenchness to a London stage.

Anna Sam records the mendacious and the mundane that she overhears at the supermarket checkout.

Sam recently retired after eight years working as a hôtesse de caisse (cash till hostess) — that was her official title. Less officially, she was a beepeuse (a woman who beeps).  She was doing it to bankroll her university degree in French literature — not that the customers knew, or would have cared.

Anna Sam overhead humanity at its meanest and most idiotic. Couples surreptitiously kissing in the frozen food section, or having sex next to the detergents. People so umbilically attached to their mobile phones that that they didn’t stop to say “please” or “thank you.” Mothers telling their children: “If you don’t work hard at school, you’ll end up a like that lady behind the counter.” And when she clocked off and went home, Sam couldn’t stop hearing the beep…beep…beep of the scanner. She recorded her observations in a blog, which became a book, Les Tribulations d’une Caissière (translated into several languages including English).  Her fame may yet spread, with talk of a movie.

Also in the pod, the UN Security Council resolution that got lost in translation. Resolution 242. is one of the Security Council’s most famous documents, the so-called land-for-peace concept in the Middle East. The French and English versions don’t quite say the same thing. The result? Confusion and conflict, with no end in sight. Not a good advertisement for translation or multilingualism.

And to round things off, we hear from the founders of Meena, an Arabic-English bilingual poetry journal, out of the U.S. port of New Orleans and the Egyptian port of Alexandria. (Meena means port of entry). Arabic never did sound so sweet.

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Voting, vowing and singing in a foreign language

You may know this type of person: the guy — and it usually is a guy — who needs to know everything that everyone around him is saying. This is  a problem if everyone around him is speaking in a language he doesn’t understand. I have trained myself not to be that guy, but I know plenty of other reporters who are him. In a potentially insecure situation, you want to know what people are saying, especially if those people — say, your translator and your driver — appear to be in vociferous disagreement.

So even though I try not to be Mr Need-to-Know, the pod this week pays tribute to him. We have a couple of stories in which it really would have been useful to know what was being said.  First, we hear about Korean-Americans in Flushing, New York.  A community group, MinKwon Center for Community Action, tried to persuade some of these Korean-speakers to vote in November’s midterms. They found that many of these potential voters didn’t speak much English. And they didn’t speak much American election-ese either. All of which made it difficult for them to choose candidates, or see any point in doing so. Check out Alex G’s photo-set here.

Then, one of those throwaway-funny stories that’s also quite sad.  You may have seen the recent video of a wedding vow renewal ceremony in the Maldives. The couple in question were Swiss. The language of the ceremony was Dhivehi, not a word of which the couple understood. During the ceremony, things were said that shouldn’t have been said — curses, insults. The couple was oblivious until it was too late. They’re probably mortified. So is the tourism-dependent Maldivian government.

Also in this week’s pod,  a  master offers classes in Islamic calligraphy his Arlington, Virginia home. Mohamed Zakariya has been teaching calligraphy for more than 20 years, and practising it for more than 50 years. Zakariya grew up in California and was first turned on to Koranic calligraphy during a trip to Morocco. As well as teach, he has designed a stamp for the US Postal Service. He wrote an inscription that Barack Obama gave to the King of Saudi Arabia.

Finally, performing in a language that you don’t understand. I remember performing in a play at an art school in Denmark. At the time, my Danish was virtually non-existent. So my Danish friends were astonished to hear me utter complicated phrases perfectly. (Don’t knock memorization and repetition…) It so impressed them that they didn’t notice that I couldn’t act to save my life. Broadway star Amra-Faye Wright (pictured) went several steps further: first, she can act. She performed her role as Velma Kelly in the musical Chicago in Japanese, in Tokyo. Doing that got her interested in the language; she’s still taking classes in Japanese.

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The English-only movement in America

A conversation about making English the only official language in the United States. Tim Schultz, lobbyist with Washington-based US English makes the case for this, ahead of an English-only vote in Oklahoma.

This is not the usual fare on The World in Words: we don’t often offer the microphone to people who discourage the use of other languages. But Schultz argues that English is what keeps America — a land of immigrants and therefore of many languages — intact. He believes that Spanish in particular is fast becoming an unofficial official language here (if that makes sense). He says government agencies use Spanish and other languages without thinking about the message they are sending. What they should be doing, he says, is using English so that non-English speakers are encouraged to learn the language, and succeed in their adopted homeland. Finally, he acknowledges that bigots and racists may be among the supporters of English Only. But as far as he’s concerned, they do not form the mainstream, nor does he share their views.

Also, an election ad in Chinese, aimed at Americans who don’t speak Chinese. This comes courtesy of conservative think tank/advocacy group Citizens Against Government Waste, which clearly doesn’t think this glossy ad in a foreign language is a waste of money.

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Aussie English and proper English

Not that Australian English isn’t proper…

English is so widely and variously spoken that it barely can be called a single language. That hasn’t stopped grammar stickler Simon Heffer from trying to re-establish order.  The man is seriously old school, and he doesn’t like what any of Britain’s new schools are teaching –or failing to teach — about English usage. We take a trip with Heffer to a school in Suffolk, where he makes the case for his version of correct English: the difference, for example, between I will and I shall. Heffer doesn’t like it when English speakers get in a muddle over foreign terms. The Italian term panini, meaning sandwiches, has essentially become an English word. Most of us either don’t know or don’t worry that panini is plural.  Heffer, though, does. If he’s buying just one sandwich, he will insist on asking for a panino.

No-one’s going to arrest him for that.

Heffer, of course, is far from alone in trying to control our use of  the language, before it descends into hellish and unseemly chaos, no doubt taking us with it.  In the eighteenth century,  English bishop Robert Lowth tried something far more proactive: he laid out a set of  grammar rules for English that were, essentially, borrowed from Latin. To that end, he criticized the likes of Shakespeare, Donne and Milton for their “false syntax”.   Podcast contributor Elise Hahl says Lowth partially won his fight for the Latinization of English grammar. She says that to this day, English is the poorer for it. That said, we  hold up Shakespeare today as the numero uno Literary God of the English language, not least because of his inventive rule-breaking. So maybe Shakespeare and loose English got their revenge.

Also in the pod, poet Les Murray describes some of the more colorful expressions of Australian English: papped, for example, means snapped by paperazzi (or, I suppose, paperazzo if there’s only one photographer, yes Simon?); a window licker means a voyeur.  The keeper of the Australian English flame, by the way, is the Macquarie Dictionary, well worth checking out.

Finally, we check in on a language school in India where the teachers have a strong sense of what constitutes proper English. Mr Heffer might approve.

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For more on the endless variations of English, check out our discussion of Rotten English in this podcast from 2008.


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