VoN #5: Power to the people (not those ones)

This week's links roundup, featuring bribes for NIMBYs, the value of diagnosis, (hopefully) the end of terrible touchscreen controls in cars, and oh no I did a podcast.

Welcome to the fifth links round-up of the year, and to celebrate I’ve launched a little podcast project with James O’Malley of Postcode Address File fame: The Abundance Agenda. It’s an excuse for us to go full YIMBY, talking about the issues of the day from a pro-growth, pro-abundance perspective. It’s coming out weekly, and you can check out the first episode wherever you get your podcasts. That mildly-embarrassing news aside, let’s get on with it:

Photo by Jerry Wang on Unsplash

Our overdiagnosis epidemic

A question that’s long troubled me is the value of a diagnosis. Obviously it depends on the condition, but all things being equal: there are people for whom diagnosis is a positive thing, something that empowers them with the tools to make sense of their situation, take control of it, and live their best lives; while for others diagnosis seems to be profoundly self-limiting, setting walls around their existence. Medical dramas teach us that diagnosis is the ultimate goal, the triumphant moment or salvation for any patient, but in reality it’s more of an inflection point: people in the same situation can respond very differently and end up on wildly divergent paths.

The idea that diagnosis might not always be positive raises unsettling questions: has the move to expand diagnosis in recent decades gone too far, and are we distorting our understanding of some conditions as a result? That tension is reflected in this absolute head-scratcher of a quote from Hannah Barnes in the New Statesman:

Miles, a retired 60-year-old banker, married with three children, received his diagnosis at 54. Like Poppy, autism is part of his identity. He doesn’t see it as a disability and doesn’t accept the label “autism spectrum disorder” either. He sees “the words ‘spectrum’ and ‘disorder’ as pejorative”. He doesn’t accept that “some people with autism are much more disabled than others” or that for them the diagnosis isn’t a positive, but rather, required to receive help.

Why does this misalignment matter? Two reasons spring to mind. The first is that for those people who have serious disabilities as a result of autism, this kind of rhetoric erases their experience and sucks the oxygen out of any discussion of their needs. There’s something quite callous in literally denying that a disability exists as such, describing even the notion of disability as ‘pejorative’, especially if you regard yourself as essentially abled.

The second, more clinical reason, is that overdiagnosis can lead to overtreatment, and overtreatment in conditions like autism is remarkably understudied:

Astonishingly, a lot of research doesn’t consider whether treatments might be harmful. A study that looked at 150 (non-drug) early autism-intervention projects found 139 did not measure harms at all – even when people withdrew because of adverse reactions. The researchers seemed certain that their “interventions were always for the best… that few seemed to feel the need to look for downsides”.

Something you learn quite quickly if you analyse clinical records is that most diagnosis is far from binary - in fact doctors are often reluctant to offer a concrete diagnosis at all. The bounds around any disease or condition - physical or mental - are often much fuzzier than people assume; and while researchers are constantly trying to refine those limits, it’s very much a work in progress. For that reason it’s good to see vigorous debate emerging in recent times about the rate and breadth of diagnosis of certain conditions - it’s science working the way it should be.

Power to the People

I don’t eat marmalade, but if I did I would have got some before reading yesterday’s Playbook just so I could drop it.

Labour goes electric: Proposals to give thousands of residents living within 500 meters of power infrastructure (like pylons and onshore wind farms) up to £250 off their bills have netted the Times’ splash. The policy is aimed at sweetening the pill of new projects by reducing average bills by almost 40 percent a year, and would be paid for by energy firms, according to Oliver Wright and Chris Smyth, who got the scoop.

There’s some good stuff in Labour’s plans to save national infrastructure from the forces of NIMBYdom, not least their commitment to reducing the endless list of public bodies that demand a veto on every project, but this move is infuriating. There is already a reward that people get for allowing power lines to be built - it’s called ‘having electricity’.

Bribing people to allow vital services to be built sets a horrendous precedent for future growth - if we’re giving bribes for pylons, why not bridges, railways, water networks or roads? - and of course it’s energy consumers who have to pay for this, creating a postcode lottery for electricity prices that will probably result in more rural, low density neighbourhoods chucking cash back at denser towns and cities.

Ian Leslie: What is Trump Like up close?

One of my long-standing frustrations with coverage of Trump is that he’s so often portrayed as a kind of avaricious cartoon villain that people tend to overlook his real motives. It’s one of the reasons I find talk of ‘kompromat’ and ‘Russian assets’ so unconvincing: you don’t need these things to explain the behaviour of a wrestling-inspired man producing the movie of his life, in which he casts himself as the world’s greatest deal-maker.

The FT’s Jemima Kelly is one of the few British journalists to have spent time at the court of Trump - Mar-a-lago - and her interview with Ian Leslie is a fascinating insight into the culture surrounding the man, and indeed the man himself.

Jemima Kelly: What Is Trump Like Up Close?

Is this finally the end of awful touchscreen controls in cars?

Of all the many things that have made life worse in the last ten years, the rise of touchscreen controls in cars has to rank as one of the dumbest. Anyone who has ever driven a car knows that deleting physical, tactile controls in favour of something a driver has to look at and scroll through is homicidally stupid. Possibly my favourite feature on my Jaguar are the big mechanical A/C control dials on the centre console that control the passenger or driver side temperature with a deft fingering of a ring.

Sadly touchscreens are going nowhere - now that all cars have to fit reversing cameras, screens are required to display the feed - but fortunately, the bosses at Volkswagen have woken from their Tesla-induced design slumber. They’ve committed to reintroducing physical controls and haptic buttons on all cars from now on. Not only that, but Volkswagen’s design chief, Andreas Mindt, has issued a remarkable, grovelling apology:

“We will never, ever make this mistake any more. On the steering wheel, we will have physical buttons. No guessing any more. There's feedback, it's real, and people love this. Honestly, it's a car. It's not a phone: it's a car.”

Which is certainly progress, but raises a serious and unanswered question - what on Earth went wrong with the culture in Volkswagen’s design team that such a terrible, dangerously bad idea was ever implemented in the first place? How were the problems not obvious from the moment someone sat in the driver’s seat in one of their own cars? How has it taken them several years to realise that a car is a car and not a phone?

The first signs of spring

Spring has sprung, our blackthorn is blossoming, daffodils are blooming, the first butterflies are flitting around our pond, and the weird guy down the road is in short shorts again, which means it must be time for… the Peter Hitchens Annual Campaign Against Summer Time (PHACAST).

I’ll be looking into this topic in our next <plug>podcast</plug>, but one thing that surprised me, given this tends to be looked on as a niche issue, is that support for the status quo is weaker than you’d think. A slight irony is that the most likely outcome of any change would be a permanent move to GMT+1, which is pretty much the opposite of what Hitchens is after. For what it’s worth I don’t really agree with his arguments, but he makes an important (and poetic) point about the political value of time:

Once, the peoples on either side of the Bering Strait would have held to the same time, fished the same seas, spoken the same language. But the deep political division that runs through that bleak and icy piece of ocean made it convenient to route the zig-zagging International Date Line between the two superpowers, and there it was. The wild fluctuations of time in the old USSR were likewise the result of political gestures. And the black mornings in Kashgar were a pure demonstration of power. It said : ‘We rule here. You do not. Even the dawn obeys us.’

The Abundance Agenda

Do please sign up to the Abundance Agenda - we’ve got an exciting interview coming in next week’s episode that I can’t wait to share with you. Otherwise, see you next Tuesday for an essay on another massive failure in Britain’s transport infrastructure…

Oh, and don’t forget to follow me on BlueSky.