Tom Salinsky

Doctor Who - Series 5 - Episode 13 - The Big Bang

Spoilers abound! Keep away if you haven’t seen the episode.

I wrote last week that Steven Moffat had painted himself into a corner somewhat. This episode saw him not so much leap the wet paint in a single bound as redefine the notions of “paint”, “wet” and “corner”. This is a totally different episode to The Pandorica Opens in a quite remarkable way – so much so that at times it barely feels like a continuation of the same story.

Much of it is absolutely dazzling. The return to the time and place of The Eleventh Hour, the brief sketch of a starless Earth (recalling Asimov’s famous short story “Nightfall”), the reveal of Amy inside the Pandorica “Okay kid, here’s where it gets complicated” and that’s just before the titles roll. Some of it is genuinely affecting – Rory’s double millennium stint on guard duty is a beautiful conceit – much of it is terribly funny – “I wear a fez now. Fezzes are cool. *toss* *zap* – a lot of it is both complicated and satisfying – Amelia is thirsty because the Doctor stole her drink in the past to give to her now because she’s complaining of thirst.

However, much of it is also very dry. As the Doctor bounces back-and-forward in time, we delight in seeing the pieces of the puzzle come together, but it tends to feel more like completing a Sudoku than the catharsis of a dramatic narrative. Part of the problem is that stakes having been raised through the roof and then up another twenty storeys last week, many of the solutions come very easily this week. Moffat’s a rigorous enough writer to have provided one-line explanations for most if not all of the following gripes, but the fact is that none of them feel properly integrated into the story. A contradiction is still a contradiction, even with a throwaway pseudoexplanation.

• Last week the Pandorica was impossible to open and the Doctor was trapped inside it forever. This week it can be opened and closed at will simply by waving the ever-popular sonic screwdriver at it.
• Last week the Pandorica was a device which rendered the Doctor incapable of further action. This week it regenerates anyone put inside it.
• Travelling in time is difficult which is why so few people can do it and why the TARDIS is so valuable. The time bracelet is repeatedly described as crude and nasty, presumably in the hope that we will never notice that it is in fact pinpoint and to-the-second accurate every single time it is used, instantaneous and in general better and more convenient than the often-unreliable TARDIS in almost every way.
• The whole idea of a “restoration field” is bunkum. For an explanation as to why, see my future blog post on the difference between science and magic.
• Stone Daleks!?

It’s that last point that I want to address now. As noted in the blog last week, as well as elsewhere, the supervillain alliance is risible as soon as you give it a moment’s serious thought. Moffat’s solution to this problem is to simply not include them in part two. In fact, throughout this peculiar episode, he simply drops concepts when they have no further role to play; Amelia disappears in the middle of the museum sequence with – again – only a single line to cover, Rory is controlled by the Nestenes only when it is required that he should be and so on.

What this means, and what adds to the Sudoku-feeling of this episode, is that there is no charismatic and yet hissable villain in whose downfall we can rejoice. Yet, this is not peculiar among Moffat scripts. Here’s a quick recap of his stories and their “villains”.

• The Empty Child / The Doctor Dances – mindless nanogenes doing what they’ve been programmed to do.
• The Girl in the Fireplace – mindless clockwork robots doing what they’ve been programmed to do.
• Blink – characterless statues doing what their nature dictates
• Silence in the Library / Forest of the Dead – characterless shadows doing what their nature dictates
• The Eleventh Hour – mindless police force hunting criminal by-the-book
• The Beast Below – political brainwashing system
• The Time of Angels / Flesh and Stone – as Blink
• The Pandorica Opens / The Big Bang – apparently an alliance of supervillains, but actually what must be overcome is not the alliance but the fact of the universe having been extinguished

Not one good villain among them. The Eleventh Hour probably gets nearest. Prisoner Zero him/her/itself gloats in a suitably villainous way, but isn’t the main foe. In the same time period, other writers gave us The Editor, The Dalek Emperor, Mr Finch, John Lumic, The Family of Blood, The Master, Miss Foster, Davros, the Dream Lord and Restac. What’s Moffat playing at?

Then there’s the list of things which simply weren’t explained at all – some of these were trailed into the next series but many were never even mentioned.

• Why doesn’t Amy remember the events of The Stolen Earth?
• Why should the TARDIS exploding extinguish every star in the universe?
• If the Earth is orbiting the TARDIS as it explodes, just where is that brick wall which River Song can’t get past?
• How does remembering the Doctor bring him back to life anyway?
• Who is River Song and what was she in prison for?

Now, all this may sound as if I didn’t much like it, but the fact is I really, really did. The lack of a good villain does make it hard for the Doctor’s victory to resonate, and the incomprehensible scale of the problem means that the solution seems intellectually interesting rather than emotionally satisfying, but there are moments of sweetness, tenderness, and even greatness at such frequent intervals, that as severe as some of these problems sound, they are mere niggles when you actually sit and watch the story unfold.

River Song’s extermination of the stone Dalek, the dying Doctor’s last words inside the Pandorica, “I escaped! I love it when I do that” followed by the horrible realisation that he is simply pausing on the threshold of death, and most spectacularly, brilliantly, jawdroppingly wonderful of all – Amy’s realisation that what her wedding is missing is Something Old, Something New, Something Borrowed and Something Dimensionally Transcendental.

Then Matt Smith dances like a loon, a pair of married companions hop into the TARDIS for the first time ever and we’re off to the Orient Express it seems. Whew.

A fitting climax to a thirteen week run which was often astonishing, sometimes frustrating, but never (almost never) less than entertaining. I hope that next year the new production team will feel a little more secure in their roles, and some of wrinkles will be ironed out.

In the meantime, I’m going to see what else this blog is good for, but if nothing else, I’ll be back to review the Christmas special. Geronimo! Meantime here’s my summation of Series Five.

The Eleventh Hour: good introduction to the new team. 4/5
The Beast Below: didn’t really make sense, but I was captivated by the energy and oddness of it all. 4½/5
Victory of the Daleks: nadir of series five. 2/5
The Time of Angels / Flesh and Stone: practically perfect. 5/5
The Vampires of Venice: better than the Dalek nonsense, but only just 2½/5
Amy’s Choice: slight but engaging. 3½/5
The Hungry Earth / Cold Blood: graceless but efficient with a killer ending. 4/5
Vincent and the Doctor: horrid. 2/5
The Lodger: flawed but enjoyable. 3/5
The Pandorica Opens / The Big Bang: the best and the worst this series has had to offer, but more of the former than the latter. 4/5

Doctor Who - Series 5 - Episode 12 - The Pandorica Opens

Spoilers!

Now, let’s have a chat about season finales.

In the 1960s, Doctor Who was pretty much a year-round production. The first year saw 42 episodes produced and transmitted on a weekly basis, with a further four-part story (later edited down to three parts) recorded and then held over to start the new season after only a seven week gap. In the seventies, the workload was scaled back to 26 episodes a year (today we have half the episodes each year, but they’re double the length) but again, the practice of “holding over” one story to start the next season was maintained – so for example, even Robot, Tom Baker’s first story, was recorded immediately after work had finished on Planet of the Spiders and by the outgoing Jon Pertwee production team.

Throughout these years, the season finale was often nothing special. Sometimes, as with Planet of the Spiders or The Green Death, these end-of-season stories happened to coincide with changes in the regular cast, but equally such changes could happen in mid-season as with The Hand of Fear. More importantly, in all other ways these stories were not vastly different from those which were transmitted either side of them.

In the late seventies and early eighties, each season did tend to come to a fairly definite end, following which the production office would briefly shut down and then gear up again for the following year’s onslaught. This did mean that the final story of each season tended to have a fairly obviously defining characteristic. It was the one where they’d already spent all the money – Time-Flight being the most obvious culprit here. When Peter Davison left, producer John Nathan-Turner took the decision to move the regeneration story up one, so the season finale is not the regeneration, it’s the first full story of the new Doctor (and obviously done on the cheap).

It may also be worth noting that these two stories – Peter Davison’s final outing, The Caves of Androzani, and Colin Baker’s first effort, The Twin Dilemma, recently came first and last respectively in the Doctor Who Magazine poll of all stories ever. That these two stories, transmitted consecutively could be so wildly divergent is an indication of just how little quality control was being effected by the then producer.

In the new era, things are very different. With one person in the role of both executive producer – having overall creative control of the series – and head writer – contributing the lion’s share of the scripts – an entire season can be designed with a beginning, middle and end. Russell T Davies wrote an unprecedented eight out of 13 episodes for Series One, transmitted in 2005, including two out of the three two-parters, and including the two-part season finale. For the first time, a season of Doctor Who stories was itself telling one longer story. (Successfully, that is.) The “Bad Wolf” clues, dropped as early as the very first episode, coalesced into a hugely dramatic showdown between the new, battle-scarred Doctor, and an entire army of space-faring Daleks. It was an astonishingly climactic end to a season which looks a little ropey and uncertain in places today, but which five years ago did the impossible – it made Doctor Who viable again.

This was topped with almost effortless ease in 2006 with what might be my very favourite episode of the revived series to date. (No, it’s Blink. No it’s Midnight. Wait – I forgot about Human Nature.) Not for the rather implausible Torchwood business, not for all that nonsense about the Void being a cosmic hoover, not even for the fan-pleasing yet wittily-done Dalek vs Cybermen showdown (“this isn’t war, this is pest control”) but for the heart-wrenching, gut-aching Bad Wolf Bay farewell between the Doctor and Rose. A friend of ours brought her ten-year old daughter round a couple of days after Doomsday went out. She’d missed it, so we let her watch it as the grown-ups talked. As Rose struggled to cling on to that lever, we gradually stopped talking and began watching the screen. And by the time the Doctor was burning up a sun just to say “goodbye”, all four of us were sobbing uncontrollably.

This, of course, creates a problem.

Now, each season finale has to be bigger, more awesome, more show-stopping, more heart-tugging, and more spectacular than all those which preceded it. And ideally in a different way. In the 2007 series, Rusty got away with this, but only just. The return of the Master in Utopia is brilliantly handled, The Sound of Drums successfully gets our heroes into All Sorts Of Trouble, while pulling together strands from earlier episodes, and Last of the Time Lords manages to make the best of the inevitable reset switch with a couple of useful reversals, the sense that some of the participants at least have not been reset and so have paid a price for their endeavours, and for a real look at what being the last of your kind (such a Doctor Who cliché!) actually means. But, by now the cracks are beginning to show.

The Stolen Earth and Journey’s End are colossally self-indulgent and the return of Davros is muffled by the presence of too many other villains and allies all competing for our attention. Then the final episode shakes off any goodwill it might have accumulated by revisited and traducing that final scene in Doomsday. I thought the fourth series was in general very strong and I liked Donna enormously, but Journey’s End would have been a fucksight better without Rose in it. And probably without Davros too.

Which brings us (vaulting over The End of Time – this blog post is long enough as it is) to Mr Moffat’s first go. Which option will he take? Bigger and better – more and more old foes and returning friends, or something smaller, darker and more Silence in the Library-esque? Well, now we have our answer. Like The Hungry Earth, and The Stolen Earth before it, much of The Pandorica Opens is teasing. We all know, as if we haven’t guessed from the end of The Eleventh Hour, that the contents of the “Pandorica” will be revealed in the closing minutes of this episode. The question is not where will we arrive – it’s how entertaining will the journey be? But Moffat also has a second significant problem of expectations to overcome. The longer he puts off telling us what The Pandorica is and what it contains (and, as I say, he’s been putting it off for around ten episodes now!) the more fuckstaggeringlyawesome it has to be when it’s finally unveiled.

Let’s take the first of these problems first. In hindsight, it’s pretty obvious that that the Doctor was the only feasible candidate for the contents of the Pandorica. After all this build up, it can’t just be Thorax Last of the Huggliubdiums, of whom we have never heard before. It has to be something reincorporated from earlier in the show’s mythos, and that probably means from earlier this series. So that very long pretitles sequence serves double-duty. As well as setting up the story that is to come, it also rules out a number of possible, if not exactly probable, candidates. River Song? Nope. Churchill? Nope. Van Gogh!? Not on your life. Liz Ten?? And then, fifteen minutes before the end, all the new series’ major monsters crop up, also (apparently) keen to see what The Pandorica contains. So, it doesn’t contain Daleks (classic or shit models), Cybermen, Sontarans, Autons, Hoix, Blowfish or Weevil either. And we’ve heard no rumours of returning companions (good, leave Rose Tyler where she is please) and it’s too early for a rematch with The Master so unless it’s the surprise reappearance of the Menoptra (you laugh, but who ever thought we’d see the Macra again!?) it has to be the Doctor himself.

What comes between the arrival at Stonehenge and the opening of the Pandorica is therefore, once again, just delaying tactics, but what delaying tactics they are, and how many other revelations are packed in to this? The Doctor and Amy’s hilarious and terrifying encounter with an amputee Cybermen, the striking reappearance of Roranicus, Amy’s remark that Pandora’s Box was her favourite book, the gorgeous set design and location filming, and any number of quotable one-liners (“I hate good wizards in fairy tales. They always turn out to be him.”), all add up to a thoroughly engrossing, exciting, suspenseful and fan-pleasing forty minutes.

The last five minutes does see Moffat painting himself into a corner a wee bit. As with The Master broadcasting to the “peoples of the universe” in part four of Logopolis, the need to raise the threat level to cataclysmic proportions comes at the cost of a certain level of credibility. The quadruple-threat cliffhanger (Doc’s in the box, Amy’s shot by Rory, River’s stuck in an exploding TARDIS and the universe itself is being extinguished) is written and staged with enough vigour and energy that I was just about able to buy it, but stop and think, even for one moment, about this “alliance” and what it means, and how it was brought about, and the whole thing quickly becomes laughable, as a number of hilariously satirical threads on Gallifrey Base demonstrate (“What did they all say while waiting to surprise the Doctor?”, “The Alliance Conference Call”, “What did they all say after the Doctor went into the box?”).

But, I have faith that Moffat can bring all this together, maybe even confront the reality of this alliance, as RTD confronted the reality of taking a young woman away from her family and friends on a tour of the universe. I have no idea how The Big Bang will resolve any of this, but if I know my Moffat, the clues are already in front of us. So here’s what I’ll be looking out for on Saturday night.

• “Amy, does it bother you that nothing about your life makes any sense?”
• The crack removing people from ever having existed
• What else does Amy remember – what else did the Doctor implore her to remember?
• What has Amy forgotten and why?
• What else is in Amy’s head?
• What was River Song in prison for?
• The Pandorica is a “fairy tale”, according to the Doctor
• 26 / 06 / 2010.

See you on Saturday!

Doctor Who - Season 5 - Episode 11 - "The Lodger"

Spoilers ahead, but as this is a week late, I shouldn’t think this is too big a problem.

So, Moffat rounds up all of his sit-com buddies and gets Simon “Men Behaving Badly” Nye to write an episode which turns out to be a rather nice little “bottle show”. He gets Richard “Vicar of Dibley” Curtis to write another, which pleased some with what they saw as its heartfelt artistic passion, but which so irritated me with its cack-handed monster that I couldn’t buy into the emotion of the climactic scenes.

So it’s left to Gareth “The Shakespeare Code” Roberts to give us Timelords Behaving Badly, also known as the Smith and Corden show. Unfortunately for Doctor Who fans, this was within days of Corden and Patrick Stewart making total twats of themselves at that awards ceremony, and so it was with a certain amount of trepidation that we approached this slightly unusual episode.

I thought that the set-up was fresh and funny. I like the idea of The Doctor having to spend several days passing as human, without the aid of a chameleon arch and a load of borrowed memories, without a companion to fall back on, and with the added complication of being dropped into a will-they-won’t-they-best-friends-each-too-scared-to-make-the-first-move situation. And, to his credit, Coren played his part with sincerity and wit and Daisy Haggard – so good recently in Psychoville – is also suitably vulnerable and yet not pitiable.

Add to this a wonderfully creepy mystery up the stairs and Karen Gillan making the absolute most of the pretty limited opportunities she’s given and we should be all set, right? Right? Sadly, this is yet another near miss, in a season which has been littered with them. I’ve long said that history will record that Russell T Davies’ chief contribution to Doctor Who, once it was actually back on the air, was the care that he lavished on every single script, whether it had his name on it or not. Some, he simply burnished up. Others, like The Satan Pit, he rewrote from top to bottom. When he didn’t perform uncredited rewrites, either for contractual reasons as with Fear Her, or due to illness as with Daleks in Manhattan, the results were generally unpopular stories which languished at the bottom of season polls. Possibly the reason that some of his credited stories were not so well received is precisely because only one mind is at work on them.

Moffat is thought to have a rather more hands-off approach to scripts. Pitching ideas to writers, suggesting plot turns here or character beats there. Protecting the tone through the production process, but nothing like the kind of top-to-bottom rewriting that the horribly overworked Davies indulged in. The result is that many of this season’s scripts – especially those without the name of the executive producer on them – feel a little undercooked, or have holes in the plotting which let them down.

The Lodger is let down in two different but equally serious ways. The first is that, with no passionately ranting Welshman babbling about “truth”, too many gags have made their way in which can’t be justified beyond “wouldn’t it be funny if…?” The Doctor’s omelette-making is overdone, his behaviour in Fatty’s office does nothing to earn the praise which Fatty’s boss lavishes on him, his lack of knowledge social niceties is totally at odds with the Third Doctor’s easy bonhomie with UNIT soliders and Whitehall penpushers; his bewilderment at the sport of football is hard to take following the Fourth and especially the Fifth Doctor’s fondness for cricket, and his inability to integrate with Fatty and Doe-eyes is almost impossible to accept as a continuation of the Tenth Doctor’s Christmas Dinner with Rose and her family.

All of which I could just about let go, if not for the fact that they fumble the climax so badly that it calls into question almost all of the preceding half-hour. Once Doe-eyes goes upstairs to her apparent doom, we the audience are well aware that the stakes are suddenly much higher than they were. But the Doctor has been steadfastly refusing to mount those stairs and find out what has been going on up there for days, letting innocents march to their death while he twats about on the football pitch or spits out wine or chats to Amy in the TARDIS. Suddenly, he has no reason to wait any longer, but all that’s changed is that Fatty’s caught him out. Any reason to wait still exists. If there was no reason to wait then he’s just let all those people die because… well, because pretending to be human was more fun!?

Pretty much all of which could have been avoided if he’d known it was Daisy Haggard up there, but he doesn’t. He and Fatty run up the stairs, not knowing who they’re going to find. The final scene is well-done and if the slack plotting didn’t ruin it for you, then Fatty and Doe-eyes’ eventual reunion is both neat, resolving both plots at once, and satisfying, but it’s a shame that the villain is yet another Moffat implacable robot on auto-pilot, a reprise of the Chula nanogenes from The Doctor Dances, the clockwork robots from The Girl in the Fireplace, or the Atraxi from The Eleventh Hour.

So, some funny lines. Some charming performances. A novel situation, but a lack of rigor, truth and care which left me more let down than entertained. Neither the disaster which this clash of genres might have been, nor the triumph given the talent on display. Three stars.

Doctor Who - Series 5 Episode 10 - Vincent and the Doctor

Spoilers!

Doctor Who is rightly praised for the extraordinary flexibility of its format. Not content with science-fiction adventure stories, the series can encompass political thrillers, bedroom farces, psychological horror, childish whimsy and pretty much anything else you can think of. Even when the series settles down and finds something it’s good at, like base-under-siege stories, a story like The Mind Robber will come along and upset the apple cart. Sometimes, like Troughton’s adventures in the Land of Fiction, these experimental efforts become generally very well-regarded. Others, fandom declines to clasp to their bosom quite so firmly, such as The Gunfighters. Still others remain controversial – loved by some, hated by many – such as Love & Monsters.

Vincent and the Doctor was certainly an experiment, tackling the psychology of depression while setting a beloved artist in his historical context, all shot through the prism of Steven Moffat’s “fairy tale” vision of the series, and including a few brief mentions of the ongoing series arc. I wholeheartedly support this experimentation with the formula. I also thought the results were almost totally unsuccessful.

This is of course, merely opinion, and rash is the critic who attempts to give mere opinions the weight of facts. It is not true to say that Vincent and the Doctor is unsuccessful. Good friends and respected critics found it profoundly moving and exciting (and it is, of course, much less risky and exposing to sit on the sidelines and grumble about how manipulative a piece of art is, than to express your wholehearted admiration and love for it). It does, however, remain my opinion that Vincent and the Doctor did not work for me at all.

The pre-titles sequence is almost identical to the opening of The Time of Angels, with The Doctor and Amy once again discovering something odd in a museum artefact and charging off to find out what’s wrong with it, only here it’s done without any panache or grace. It’s not at all clear why a visit to the Musée d’Orsay should be a special treat for Amy, not is it at all clear why there are in such a hurry to race back to 1890 given that 1890 will wait for them to get there for as long as they like. And the justification “I know evil when I see it” (one of a handful of poorly-dubbed Matt Smith lines in this episode) is paper-thin.

So, the titles haven’t even run yet and already we’ve got a slightly awkward juxtaposition of a brief art history lecture and a sudden mysterious urgency to investigate a monster. On arrival in Provence, things brighten up a bit. Tony Curran is excellent both in appearance and in manner as the troubled Vincent, and his Scottish accent is incorporated with a sly gag. Director Jonny Campbell recreates van Gogh’s paintings in his compositions without making too big a deal of it, and the story begins to settle down.

At this point, I would have been perfectly happy if this had simply been a story of what happens when van Gogh met the Doctor and Amy, but up pops an invisible monster to remind us that this is Doctor Who. Sigh. The Krafayis is generally rather poorly realised with the Doctor not even facing the same direction as van Gogh when attempting to attack it, bits of scenery occasionally falling over, but never creating the impression that a creature is moving around, and actors being hoisted up on wires or falling over in a slightly embarrassed fashion.

Why it isn’t killing dozens of people isn’t made clear, nor is there any real connection to the rest of the story. Between only van Gogh being able to see it (and paint it), the Krayfayis itself being blind and van Gogh’s impassioned rant about being able to hear colours, Richard Curtis obviously has something in mind about what one person can see and another can’t, but it never really comes together. I suppose allowing these two plotlines to merely touch instead of intersect is preferable to desecrating van Gogh’s genius with some science fiction nonsense about his visions of the world being due to an excess of midichlorians in his blood, but the overall impression is still of a perfectly good, if slightly patronising, story about Why Vincent Van Gogh Was Sometimes A Bit Sad But Still A Jolly Good Painter, rudely elbowed out of the way for some rather clumsy science-fiction slapstick.

And then the Krafayis is dead, stabbed with an easel if that’s supposed to make this feel like more of a piece, with 15 minutes to go, which means we get undoubtedly the most questionable sequence of all – van Gogh’s return visit to the museum. Firstly, this is – for my money – somewhat overplayed at best. To the soaring strains of emo-pop, we hear Bill Nighy eulogise van Gogh’s art while the poor man stands and listens. I know it’s meant to be an uplifting and heartbreaking and yet ultimately sensitive depiction of depression, but to me it felt glib and sentimental without really connecting with anything. Secondly, and perhaps more seriously, the Doctor’s attitude towards this troubled soul’s mental health seems to me to be wildly cavalier (being shown this kind of future might drive anyone mad) and the lack of impact on the rest of van Gogh’s life, while probably truthful, did render the exercise slightly pointless. Ultimately, I simply struggled to accept the reality of any of it – even within Doctor Who’s loose fantasy context. I knew what the scene wanted of me, but I just didn’t feel that it had earned it.

As ever, there are pleasures to be had. In the scene where van Gogh, the Doctor and Amy lie on their backs looking at the stars, we get a vision of what a more restrained, more controlled, more truthful version of this story might have looked like. I’d cheerfully watch Bill Nighy (uncredited for some reason) count backwards from 1000 and I’ve no doubt he’d make it a fascinating experience. Matt Smith is absolutely brilliant once again, even when the script only gives him falling over to do, it was nice to get that quick name-check for Rory and I loved the TARDIS being fly-postered, and those posters burning off in the vortex. Ultimately, however, this was my least favourite story of the series so far, with the sole exception of Victory of the Daleks, which slips lower in my estimations with every passing day.

Two stars.

Doctor Who - Series 5 - Episode 9 - Cold Blood

Spoilers below, read on with care.

Last week, I said I was going to withhold judgement on this two-parter until I’d seen how (and if) all the set-ups were paid off. I’m pleased to say, in general they paid off handsomely. But this was also an episode of two halves. We’ll get to the last ten minutes in a second, but let’s take the Silurian story first.

It’s Stephen Moore doing a portentous voice over! Fantastic way to get me in a good mood, straight away. Totally unexpectedly, one of my favourite actors – one of those wonderful British character actors who’s been in just about everything but never, until now, Doctor Who – starts intoning gibberish over a picture of planet Earth, and even though the voice over telling us the end of the story at the start of part two is a complete steal from Doomsday, I just loved it.

And, as I predicted, the episode kicks off with all the characters who had been held in stasis, suddenly springing into life. Amy finally escapes from her shackles, Ambrose goes mental with a taser and the Doctor rings the front door bell. From here on, it’s pedal-to-the-metal, will-they-won’t-they stuff all the way to the finish, with some lovely good-news-bad-news sequences and masses and masses of Silurians, swelling further the ranks of twenty-first century Doctor Who monsters represented by two-or-three fully characterised individuals with impressive make-ups and any number of interchangeable troops, their faces covered by helmets, masks or cowls (see also the Sontarans, the Judoon, the Sycorax etc).

Is it perfect? Of course not. The Silurian/Human peace conference is unbelievably shallow and glib, as is the absurd division of Silurians into completely compassionate, open, sensitive and friendly on the one hand (Eldane, Malohkeh), and war-hungry psychopathic ape-haters on the other (Alaya, Restac). But this is Doctor Who – bold, colourful, exciting, fast-moving. Not some turgid political play at the Royal Court. Sure, they are broad brush strokes, but with performers as strong as Stephen Moore and Neve McIntosh, the script can trust them to find the shades of grey. Particularly fine was McIntosh’s little gasp of regret and grief at the sight of her sister’s corpse.

And while I’m griping, the Doctor and Eldane’s solution is also both patronising and a cheat. Patronising because the solution to the problem of sharing the planet with homo reptilia is unlikely to be as simple as pressing the pause button and getting three people to start up a new religion. A cheat because the magic decontamination thing was in no way set-up. But amid the whirl and dash and energy, I still found it hugely enjoyable, even on a second viewing. Mo never grows a character, and Eliot seems to lose his – even his dyslexia’s not mentioned again, but Tony, Nasreen and Ambrose are all vividly written and strongly played. There are also hints that we haven’t seen the last of Tony and Nasreen either.

Then there’s the last ten or so minutes. First of all, after three crackless episodes, the crack is back. Then just as I was wondering how long he’d be around for – boom! – Rory dies. Two death scenes in three episodes is quite a lot, and it’s a pity that as far as we’re concerned, Amy’s already lost him once. But to lose the memory of him too is ghastly and the Doctor’s guilt will be unbearable. One assumes that The Pandorica, when it Opens will have Rory-Restoring powers but, in the third of this episode’s triple whammies, it certainly seems to have TARDIS-fragmenting powers.

Wonderful stuff, and as we race towards the end of Series Five I can’t believe so much has gone so quickly. Cold Blood on its own is easily worth four-and-a-half stars, but I can’t completely forgive the padded-yet-garbled The Hungry Earth, so four stars for the story as a whole.

Next week – Vincent van Gogh as written by Richard Curtis.

Doctor Who - Series 5 - Episode 8 - The Hungry... wait, what?

As ever, spoilers. Read on with care.

I’m quite tempted not to review The Hungry Earth at all until after Cold Blood has gone out. Not just because this review is so late, but also because I can only remember one other two-part story in the Modern Era which has had so much set-up and so little actual story in the first part. That story was the 2008 season finale The Stolen Earth. This very curious episode is structured so as to first remove the Doctor from the action so he can have some neither terribly relevant nor terribly dramatic backstory explained to him by a convenient galactic secretary. Meanwhile, we get reintroduced to all sorts of friendly faces from the past until finally the Doctor and Rose can be reunited and the Doctor blasted by a Dalek triggering the infamous faux-regeneration. What this means is that after about the first ten minutes and before the last five, the plot hardly advances at all, and we get thirty minutes of narrative “vamping”, with almost all of the actual story crammed into a bloated 65 minute denouement.

Of course, we classic fans are used to this. Many’s the four part story which is basically a pretty decent set-up in episode one, a pretty decent climax in episode four and an awful lot of running around, being locked-up, discovering a tiny smidgeon of plot and then being locked up again in the middle episodes. And god help you if your first experience of classic Who is one of the shapeless, swampy Pertwee six-parters. The Time Monster, be named-and-shamed; Colony in Space, let’s be having you; The Monster of Peladon, stand up and be counted.

Having seen The Hungry Earth – a Pertwee nostalgia-fest, lacking only a Brigadier-substitute – many younger fans may now be tempted to go at revisit some Pertwee stories, but thankfully Chris Chibnall has picked some of the better ones to pay tribute to. Here’s the obligatory roll-call of Pertwee elements making a reappearance here – Welsh miners digging up something nasty from The Green Death, domelike incorporeal barrier over the church and its environs from The Daemons, foolishly boring to the centre of the earth from Inferno, the Silurians from, er, The Silurians and being-set-about-ten-years-in-the-future from – oh look, let’s not go there.

But where’s it all going? Bafflingly, Doctor Who Confidential claimed that the rough-cut of The Hungry Earth was a full 15 minutes overlong, and implied that this was rather unusual. And the transmitted version does bear some signs of having had the hatchet taken to it at a relatively late stage, as so many of the scenes exist simply as obviously sign-posted set-ups. Some paid off in this episode, at least to some extent, others haven’t yet. Rory’s sudden and unmotivated desire to return Amy’s ring to the TARDIS is about as blatant a device for splitting up the TARDIS crew as I can remember, but at least we leave the episode understanding that the point of him returning to the TARDIS is to discover the subterranean grave-robbing with Ambrose and Elliot. But, on the other hand, what was the point of that? If you’re trying to establish that there’s something under the ground pulling stuff down then the Doctor and Amy have managed to tell us that rather more dramatically while you’ve just been standing around and talking calmly.

Worse is to come when Elliot announces in the middle of a tension-filled countdown that he is just popping off to reclaim his headphones and nobody even blinks let alone tries to stop him. Was Chibnall hoping no-one would notice, or was a more elegant version of this, with a little more justification present in the sixty minute cut and it only looks so crass now because the story has been stripped to the bone? Except it hasn’t. Apart from PC Rory’s deadend investigation of those graves, all of that fannying around with surveillance equipment also goes nowhere, and right at the end when the Doctor and Nasreen get in the TARDIS to take a trip down to the lower caves we spend several minutes with them being buffeted around as the Silurian sciencey somethingorother screws up the TARDIS controls before depositing them exactly where they had been trying to go. Why not cut some or all of these narrative “loops” (see Terrance Dicks on writing The War Games) instead of paring back the central plot to its most basic and functional components? Why not give Amy Pond, the ostensible second lead, something to actually do instead of removing her from the action and keeping her chained up in limbo until part two?

Maybe part of the motivation for this delaying procedure was to withold the revelation that the Silurians were responsible, but in that case nobody told the BBC continuity announcer who cheerfully blew the surprise while chatting over the closing credits of the previous programme. And it’s been an open secret for weeks in any case.

Other obvious set-ups which haven’t gone anywhere yet include Elliot’s dyslexia, the Silurian “dissection” of Mo, the future Rory and Amy glimpsed on the hillside, the blue grass (mentioned two-or-three times but it hasn’t amounted to anything yet), Tony’s sting wound, the Silurian barrier which just keeps coming and going and switching the lights on and off purposelessly so far, and the Doctor’s continual promises that he will bring people back / keep everyone safe / make sure nobody dies today. Does Chibnall really have no idea what he’s doing?

Well, other evidence makes that seem a little less likely. Once we finally arrive at where a Moffat, a Davies or even a Cornell might have delivered us in half the time – the humans having to stand guard over a defiant Silurian – the script suddenly takes flight. The moral ambiguity which the Silurian backstory invites bursts into life, the Silurian make-up is fantastic, and Alaya’s taunting of Rory, Ambrose and Tony with her prescient visions of her own murder are wonderful stuff, as is the spectacular reveal of the Silurian city, hugely raising the stakes and providing a marked contrast to the rather self-consciously small human cast (“all the rest of the staff on this colossal, record-breaking drilling project drive in and overnight it can be looked after by just one bloke reading The Gruffalo”).

Will all this pay off next week (i.e. tonight)? Well, I just don’t know, and that’s what makes it so hard to give this episode a definitive rating. In amonst these structural gripes, there are many moments of charm and grace. The benefit of a smaller cast is that the actors have more room to work, and four nicely-defined human guest characters are starting to emerge – Tony, Nasreen, Ambrose and Elliot. Only Mo is a little underdeveloped so far. The being-sucked-into-the-earth effects while not perfect are at least an improvement over the Dave Chapman video wipe seen in Frontios or the Colin Baker wiggle-your-tummy-into-the-sand manoeuvre from The Ultimate Foe. Ashley Way directs with vigour and elegance and Murray Gold’s music is at its lyrical best, so there is hope. But ultimately, I will be much more inclined to forgive the clunkiness of the setting-up if the paying-off is truly spectacular. So, for now I reserve judgement. A full review of the whole two-parter will be up in a day or two.

Doctor Who - Series 5 - Episode 7 - "Amy's Choice'

As usual, this review contains spoilers, so read on with care.

One of only two writers new to Doctor Who this year (both of them veteran sit-com hands with a wealth of other experience besides – this is no longer a show which can develop new talent it seems), Simon Nye seems at first glance a curious writer to pick, but actually he fits into Moffat’s fairy tale vision of the show very neatly. As most will know, this is the season “cheapie”, filmed last to the almost audible sound of barrels scraping and wallets straining. Sometimes the season cheapie turns out to be a little gem like the shamefully overlooked Midnight. On other occasions we get the more dubious Love & Monsters or Boom Town (to say nothing of The Horns of Nimon or Time Flight). Certainly, this puts more weight on ideas than on execution, but Doctor Who has (almost) never been about visual spectacle.

Nye’s script was a very simple idea – possibly too simple. Toby Jones’ Dream Lord offers the now three-person TARDIS crew a puzzle to solve. Which is the true reality? And for a while, I was actually interested to see which it would turn out to be – forgetting the almost cast-iron Rule of Story Choices. This rule states that unless we know in advance which is the right choice (such as who such-and-such is supposed to marry) that given X choices, the hero of a story will pick none of them, either because the choice is no longer necessary or because an X+1th reveals itself. And so it proves to be here. The story has one more twist before the titles roll though, and one Nye can’t keep from us. Having promised that the Doctor knows exactly who the Dream Lord is, we have to have an explanation, and fandom primed itself for the revelation of The Celestial Toymaker, The Master or even (Verity save us) The Valeyard. This all seems a little foolish now, but we live in a post return-of-the-Macra world, so never say “never”.

The reveal that the Dream Lord was the Doctor certainly made sense of a lot of the foregoing, with or without the slightly naff space pollen (to me very redolent of Star Trek The Next Generation, both in conception and appearance) but seemed to lack any kind of sting or bite, and while the adventures in the two realities had some fun and clever moments, the key moments of death in each world were curiously muted. Why can’t we be with the Doctor and Amy as they hurtle towards that cottage? Why can’t we see the TARDIS disintegrating and the void of space wrenching them apart? Instead we just cut away.

Nye’s structure means he has to keep cutting back-and-forth between Leadworth (sorry, Upper Leadworth) and the increasingly refrigerated TARDIS with nowhere else to go and he does a decent job of continually upping the stakes, I just wanted some kind of third act complication if only for variety. But while we keep just flipping back and forth it’s all too apparent that Leadworth is where the real action is, whereas back on the TARDIS, there’s little more than chat and ponchos. This means that the performances and dialogue have to really work hard, and luckily Nye, Smith, Gillan and Darvill are all up to the task, but while the ending was satisfactory and the concept neat, I felt the whole was just a little underwhelming, with the possible exception of Amy’s reaction to Rory’s “death”, which was beautifully handled by all concerned.

A few other niggles. Why is the Doctor’s savagely cheeky line “how do you stave off the, you know, self-harm?” talked over? Why is the exterior lighting/grading suddenly so flat and EastEnders-y after the lovely tones and shades we got in what is supposed to be the same location in The Eleventh Hour? Bad weather? Another eye on the end of a pseudopod? Really!?

Three and a half stars, but I’m in a good mood cos it’s the Silurians next week!

In order to keep all of my Big Important Thoughts in one place, or at least fewer places, I’ve imported by storytelling and screenwriting blog posts from the Script Surgeon blog into here. If you haven’t read them before, there’s some good stuff there about the art and craft of story-making, with discreet plugs for the Script Surgeon service (still available!) at the end. Clever old WordPress has preserved the dates from the old blog, so basically anything from 2009 is from Script Surgeon.

So, it’s a Lib-Con coalition. Hooray! Everyone’s done the grown-up thing for the sake of the country and for the sake of a strong and stable government. And just to make sure it’s really, really stable, there won’t be another election for five years, since the new government has changed the rules and introduced fixed terms. In fact, it’s even more stable than that since the other rule-change which has whizzed by is that you now need 55% of the commons voting with you to topple the government. This apparently arbitrary figure just happens to ensure that the Tories will stay in power even if every single Lib Dem MP joins forces with Labour and votes against them. Funny that.

I mention all this, not simply as an expression of sour grapes, but because further electoral reform is likely and it’s worth looking at some of the different options which are being considered. I’m not going to bore you with the difference between Alternative Vote and Single Transferable Vote, (although god knows I could thanks to many ill-spent days and nights hacking around my student union where such things were talked of with the excitement I now reserve for a new iPhone), I’m going to take a considerably wider view, beginning with just what is so “broken” about the current system anyway.

Basically, there aren’t that many votes which actually matter in a UK general election. Only about 26 million people voted this time round (out of about 40 million who were eligible, a 65% turnout). Of those 26 million, the great majority – like me – will always vote for the same party, come what may. We don’t decide the election, only the floating voters do. But of the 650 parliamentary seats, the majority are safe. At the last election only 100-odd actually changed hands. So, politicians are attempting to influence the 500,000 or so voters who are going to vote, and are undecided, and live in marginal constituencies. The rest of us might as well not bother turning up, except to keep the BNP out.

So some voters are understandably peeved that their vote hasn’t really affected the outcome all that much, but this peeve is a trifle compared to the staggering injustice which Nick Clegg believes that the electoral system has dealt him – 23% of the popular vote, but only 9% of the parliamentary seats? In fact, such are the vagaries of our first-past-the-post system that although their share of the vote went up (by just less than 1%), they ended up with a net loss of five seats. The injustice of it all!

Now, you might argue that Nick Clegg’s Liberal Democrats have actually done all right out of first-past-the-post this time round, given that they have around half-a-dozen cabinet positions and Clegg himself is now deputy PM. You might also argue that the Lib Dems are moaning about a problem which is somewhat, if not entirely, one of their own making – if there was no significant third party, the distribution of seats in the House of Commons between Labour and Conservative would much more closely resemble the distribution of votes in the country. In other words, the Liberal Democrats could come pretty damned close to proportional representation without any complicated change to the voting system or the role of MPs, just by giving up and disbanding.

This of course is not going to happen, and here it becomes important to state the Golden Rule of Electoral Reform, which is that anyone in politics who is advocating a particular system of voting (including the existing one) is almost certainly advocating the system which would be most advantageous to them and their party, regardless what justification they give. Hence, the Liberal Democrats want a strictly proportional system, which would gain them about ninety seats. Not surprisingly, neither the Tories nor Labour want such a system as the Lib Dems’ gain is their loss.

The Tories, despite long-standing opposition to electoral reform, appeared to be offering an olive branch to the Lib Dems on this issue with David Cameron saying that he would like to see fewer MPs and constituencies of equal population sizes. Ignoring for the moment quite how it is possible to claim that anyone’s vote can count for more if the number of representatives is significantly reduced, a look at what I must call “the electoral math” reveals why. Conservatives tend to win big majorities in large, rural constituencies. Labour politicians tend to win by smaller majorities in smaller urban seats – they use their voters more efficiently. Cameron’s plan effectively means taking pairs of small Labour-held seats and pushing them together to make one Tory-sized seat, costing Labour one MP in the House of Commons every time they do it. Not surprisingly, Labour isn’t keen on this plan, and it is unlikely to help the Lib Dems out much either.

So, Labour voters (like me) favour the status quo, which – on some calculations – would hand Labour a small but workable outright majority if the votes across the country were split exactly equally across the three parties. This is not what we tell people in wine bars, however. What we generally tell people is that given the tribal, adversarial nature of our political system, where opposition parties will tend to oppose anything the government proposes simply to test those proposals, hung parliaments tend to lead to instability, indecision and deadlock. If we don’t want a rudderless ship of state, we need an electoral system which will deliver a decisive outcome and hand the party with the most support in the country a clear mandate and the political tools to get its legislation passed.

And history shows us that most attempts to run Britain in a cross-party fashion have been short-lived failures, which is why – up till recently – I’ve been banging the drum of “decisive outcome” vs “making every vote count”, pointing out that almost any proportional system would deliver a hung parliament at pretty much every election (so why is it only now that this has happened that people are saying that the current system is broken and must be fixed?). However, looking at what is actually happening at number ten at the moment, I wonder…

Politics in Britain has changed in the last thirty years. Tony Blair essentially conceded that the right had won the economic argument. Free market – yes; all-powerful unions – no; get rid of that embarrassing business about the workers controlling the means of production from the party constitution and we’re all set. It worked. New Labour was seen as a friend to business, a chum of the City and stayed in power for three historic terms. After several years of flailing about, shellshocked, the Conservatives had little option but to concede that the left had won the social argument. NHS – yes; safety net for society’s least fortunate – you betcha; and hey presto suddenly they aren’t The Nasty Party anymore.

This leaves precious little left in the way of ideology to argue about, and this does give me hope for the future of the Lib-Con Coalition. It’s not quite Lab-Con, but given that Nick Clegg’s an old Etonian toff (oh okay, he went to Westminster School, but that’s not as catchy) whose first job in politics was working for Leon Brittan, but whose party is generally seen as rather to the left of New Labour, it does sort of balance out. Far from electing the party whose spirit and values is most aligned with theirs, I think many of those undecided voters will feel like they are trying to pick the most capable management team and may be wondering why they have to pick all the people with red rosettes vs all the people in blue rosettes. Can’t they pick-and-choose?

Turns out, you can, if you’re Cleggeron. And this means that cabinet meeting might start to mean something again. And more than that – if you have to convince someone of the rightness of your policy and that someone is fundamentally motivated through years of conditioning to disagree with everything you say, then there’s a chance that we could get policy-making which is genuinely for the good of the country, and might even be evidence-based rather than locked to ideology. Now there’s a thought.

Part four is here.

TOM

I don’t think there is any evidence that a significant number of people are being harmed by choosing to go to alternative practitioners. There is undoubtedly a considerable morbidity and mortality arising from the side effects of drugs and the mistakes that happen in the conventional medicine system. Is the harm caused by inappropriate use of alternative medicine on the same scale?

Interesting. This is basically the Toyota defence isn’t it? “Until a lot more people are killed by our product, we don’t see the need to perform a recall.” Not really what I want my healthcare to be based on.

Your challenge to produce harm produced by alternative medicine “on the same scale” as that caused by evidence-based medicine does not make clear whether you want the same absolute number of corpses or the same level of morbidity per person treated. In either case, it is unlikely that I will be able to provide such evidence. In the first, less reasonable, case, despite my fears that alternative medicine fairy stories of miracle cures are distressingly seductive, it is obviously the case that almost everyone in Britain will be treated by conventional medicine at some point, but only a portion will seek alternative treatments. So even if they kill at the same rate, alternative medicine will be way behind. Even in the second, more reasonable, case, I doubt I will be able to meet this target since if someone is really sick and foolish enough to seek useless alternative therapies, it is likely that once they are at death’s door, they, or a relative, or someone will have the sense to take them to a proper doctor, and we can only hope they will be in time.

But just as we wouldn’t do without conventional medicine on the basis that a significant percentage of people who go into hospital will be killed simply because they went into hospital rather than because of the condition which brought them there, the question we should ask of homeopathic and other alternative remedies is not “what harm do they cause compared to other things in the world with the potential to do harm?” but “are they a net force for good?” or in other words “are we better off with or without them?” These calculations are not always easy to perform. Some people argue that the use of pesticides on fruits and vegetables contributes to deaths from cancer, and this is likely true. It is estimated that around 20 extra cancer deaths occur in the United States each year due to chemical pesticides. While this is a very small number (around 300 Americans die each year drowning in the bath by way of comparison), surely even 20 is too many. We should obviously get rid of these horrible carcinogens polluting our mealtimes. Alas, the immediate upshot of cutting back pesticide use would be to decrease farmers’ yields, which in turn would raise the price of their produce, which would in turn reduce the national consumption of fruits and vegetables, which would in turn increase the rate of cancers in the USA, probably adding 26,000 to the total (less the 20 who would no longer die because of exposure to pesticides). (Sources for these numbers on request).

So, let us ask what the harm caused by homeopathy is. I (and some of the commenters to this blog) have given you some examples of the horrendous consequences that can follow trusting that homeopathy will be efficacious in treating serious conditions. You say that you hope most people will have the sense to avoid magical treatments when their life is in danger, yet you seem quite sanguine at the prospect of people who are quite determined to erode this life-preserving common sense. Furthermore, the harm which homeopathy can cause is well-documented, by Simon Singh, through the campaign behind the “mass placebocide” or through this website dedicated to answering this very question. Note that Simon Singh makes the same connection that I do between homeopathy and mistrust of vaccinations. The body count due to recent refusals to vaccinate is easy to check.

Having agreed that harm from homeopathy is both possible and actual, we have to ask who it helps. Broadly, there are three kinds of people who might seek this kind of therapy.
• People suffering from serious conditions which require medical treatment. I am reassured that the Royal Homeopathic Hospital would refer these people, but still marvel at the cognitive dissonance required. Clearly, any people in this group run the serious risk of suffering quite unnecessary harm. For this group, the existence of alternative modalities is nothing but a negative. It will cause them to delay treatment.
• People suffering from self-limiting conditions which require little or no treatment in any case. These patients will not be directly harmed, except in the wallet. They will be spending money needlessly since their condition will improve on its own. This is a minor negative, but not in terms of health outcomes. It’s their money, you may argue, and they entitled to waste it however they please. Unfortunately, if they develop the belief that the alternative modality of their choice is effective in treating their minor self-limiting condition, then they may be more inclined to believe the more exotic claims made for this treatment and subsequently find themselves members of the first group. Thus, for this group also, the existence of alternative modalities is nothing but a negative.
• Finally, we come to the group which you have chosen to emphasise. Those suffering from chronic, non-life threatening conditions, for which no evidence-based treatment is offered or available. In a competitive marketplace, they are likely to get more sympathy from a quack than from a real doctor, and they may benefit in the short term from the (very powerful) placebo effect. They may even be permanently cured if they condition had no physical reality in any place (e.g. phantom limb sufferers or people who claim that mobile phone masts give them migraines). While I agree that some people in this group are made to feel better, I do not believe that this benefit is worth the cost, nor do I agree that the Royal Homeopathic Hospital (and other less scrupulous purveyors of fairy stories) is the best possible means of providing this kind of comfort. Relaxation techniques, improved diet, better trained GPs who understand the importance of providing emotional support to their patients and a better patient understanding of how psychosomatic illnesses affect us are all available and likely to be efficacious. You can probably add to that list.

So, no, I don’t believe that the harm done by homeopathy is on the scale of the harm done by conventional medicine. But conventional medicine does tremendous amounts of good which is absolutely unavailable anywhere else, whereas homeopathy does quite a lot of insidious harm, for only a little bit of good, almost all of which is available elsewhere.

Overall what makes me cross is big companies misleading people about important issues such as health. It isn’t just homeopaths who do this. Idiotic media celebrities like Gillian McKeith do the same thing. So do some drug companies. But lying to the general public about health is unlikely to have a positive effect on society, and institutions like the Royal Homeopathic Hospital, whether or not they cause harm themselves, make the lies of the unscrupulous so much more convincing. Campaigns like 1023 aim to provide more accurate information as a corrective to this – to help ensure that people do know that they need to be in hospital with severe chest or abdominal pain.

One of the recommendations made in the recent government Evidence Check was that homeopathy should have to be approved by NICE before being made available on the NHS. Do you think it would get NICE approval? On what grounds? If it wouldn’t, why should it be made available at no cost to patients when other more efficacious drugs are only available privately?

JOHN

I think the argument along the lines of ‘how many more people have to die before you admit I am right?’ is a bit over the top.

I think there are two areas where we are out of synch with each other. They concern the concepts of ‘health beliefs’ and ‘risk management’. I also have a problem with your relentless positivism. Science and logic and common sense are very valuable but there are other powerful forces that govern human beliefs and actions and they need to be understood rather than dismissed as simply foolish.

Risk management. Doctors deal with this every day. We are constantly having to decide whether to advise a patient to take a particular drug which has potential for good and for harm. This can be quantified to some extent. We can say, trials show that if you take aspirin your risk of a heart attack will be cut by X percent over ten years. There is also a risk that you will have a cerebral haemorrhage but the risk is much less so the odds are in favour of taking it. Often, when presented with this information, people say: but I’d rather not take any risk!  But this is impossible. It seems to be a hard concept to grasp. The other problem is that you can’t guarantee that taking the drug will have any benefit for that individual. The effect is only measurable on the population as a whole.

Health Beliefs. You argue that ‘the placebo effect’ can be more safely produced by doctors taking more time, being kind and sympathetic, being trained in psychology etc. But some people’s health beliefs are very physically based. They have very fixed ideas that only by swallowing a pill or having needles or massage or whatever can their bodily pains be relieved. Trying to argue people out of this is usually a waste of time. Often it’s based on personal experience or family traditions.

But I still think that for the overwhelming majority of people will be guided by conventional medicine when there is a really effective treatment available. I have yet to meet a patient who said, no, I’ll just have homeopathy etc. when it was a matter of life or death, or when I said, try this, we can really help you.

Maybe one can’t justify alternative medicine being paid for out of taxation or insurance. But I don’t think it will stop those people who believe in it from getting it privately if they have to. I don’t believe it should be banned by law because a few rather idiosyncratic people may wrongly choose it instead of conventional medicine when conventional medicine is in a position to prolong their lives or relieve their suffering.

That would be an abuse of their human rights. better to ban smoking if you must ban something. Or alcohol? Though, that has been tried.

And now I really have had enough of this subject. By all means have the last word. But after that,  can we talk about something else? How about euthanasia?

TOM

This seems a good place to end the conversation, as we are moreorless in agreement! I agree with everything you say about risk management and almost all of what you say about health beliefs.

I agree that for some people a physical intervention such as a pill, or a series of carefully placed needles, is required to trigger the placebo effect. You can’t argue someone in or out of the placebo effect – it isn’t a product of conscious decision-making.

I also agree that attempting to ban alternative medicine would not make it go away, any more than prohibition stopped people from drinking. Even regulating advertising of alternative medicine only encourages those who sell it to seek editorial promotion instead, which is more convincing than advertisements in any case.

So what do I want? Well, essentially just what you want – for everyone in the world to understand the difference between the claims made by evidence-based medicine and the claims made by magic-based medicine and so make informed health decisions. It’s just that you see very few people who get this wrong coming through your surgery and I read lots of blogs and listen to lots of podcasts which detail case after case, so we have formed very different views as to the scale of the problem. No doubt each of us has a somewhat skewed perspective.

The one area where I would be tempted to disagree would be on the subject of my “relentless positivism”. I am well aware that forces other than science and logic govern human beliefs and actions. However, I submit that to better understand these forces in an objective manner, the only option is to study these very forces with the tools of science and logic. But that’s not really what is under discussion here.

I imagine we’d boringly agree about euthanasia. Human dignity, relieving suffering and patients’ wishes all sometimes trump “first do no harm” but great care must be taken in exercising this option. Is that roughly your view too?