Left-handedness. Yes, it can matter

“Imagine a truly radical party of the left….which enacted legislation saying that all scissors had to be left-handed, that writing would be from right to left, that machinery and tools of all sorts should be built only in left-handed forms. One imagines that right-handers would protest at such changes, but in that case left-handers also have a legitimate protest against the present situation.” Chris McManus in Right hand, left hand (2002, Phoenix)

Right hand, left hand explores asymmetry in the world; in chemistry, in all forms of life on earth, in particle physics, and in the modern world experience of humans. The quote above comes as McManus begins to explore some of what he terms left-handed myths, such as “Left-handers die younger than right-handers” and famous right-handers erroneously claimed as lefties (Billy the Kid, Picasso, Einstein). But he also identifies some interesting, if rather banal, lefty facts.

The muppets were mostly left-handed – had Jim Henson scored one for the lefty underdog making a left-dominated puppet world? McManus deflates this notion by explaining that, as most puppeteers were right-handed, the right hand got to do the most complicated puppetry – namely working the head – so the left-hand got to control the hand as the less complicated work. (Though The Simpsons is populated with many left-handers, including Bart and Mr Burns, reflecting Matt Groening’s own left-handedness http://simpsons.wikia.com/wiki/Left-handed)

Most right-handers I have talked to about handedness did not consider handedness as having an impact in the world until it was pointed out by a lefty. And its probably fair to say that most would still not give handedness much credence as an issue of any great importance.

So, I have an idea for a TV show.

It would take a magazine format enabling a series of regular slots appealing to different parts of the audience. It could be called More than one in ten or The left bank and definitely not anything crass like Human lefts. And it would explore the world as experienced by left-handers.

Presented by lefties (perhaps Nicole Kidman and Keanu Reeves could do the honours?), it would include:

1. Nature – such as handedness in flatfish, or the left spiraling narwhal horn

2. Science – how molecules have handedness that can make significant differences, such as how the right- and left-isomers of carvone have different smells, or that the two forms of thalidomide have different biological activities, with only the right-handed form being teratogenic and being responsible for causing birth defects.

3. The arts – whether exploring famous lefty artists (Escher, Klee), or musicians (Geldof, Lydon, Hendrix, Plant).

4. The day-to-day world – my favourite section – where famous right-handers are given simple tasks to do using left-handed equipment.  Much of this would be based on my own childhood experiences:

We could all laugh at the “stupid” person not able to neatly cut a drawn circle from a piece of paper as the left-handers scissor blades when held in the right hand push apart not together, and the right sightline of the circle edge is covered by the top blade.

We would chuckle at the slanty bread and cheese slices the righty would cut with a left handed bread- or kitchen-knife.

We’d giggle at the clumsiness of righties using left handed tin openers as their weaker hand turns the handle in the opposite direction to the best use of their thumb strength, or perhaps a waiter’s bottle opener, when the blade of the cutter is upside down, and again the turning motion contradicts the strength of the hand.

Or even getting righties using a left-handed chequebook, and finding that it makes it harder to write their signature because the hand rubs up against the stub of the book, followed by having a cup of tea from a left-handed mug where the witty homily on the side can only be read whilst drinking if you hold the mug in your left hand, rather than the usual right-handed ones.

And we could have a spot where people demonstrate how right-handed so much of the world is, by making left handed examples of common gadgets (positioning credit card pin machines for left handers, not right handers; designing DIY electric tile cutting machines or two-handed Black & Decker drills left-handed; giving everyone a left-handed computer mouse as standard).

On the first programme I’d have Christopher Seed and his left-handed piano (http://www.lefthandedpiano.com/) that enables him to play the usually more complicated, tuneful parts with his stronger left hand rather than with his right when he played a standard piano. And then get Tim Minchin to try playing it (I don’t know if he is left or right-handed, but he can play the fuck out of a standard piano).

  

Okay, handedness isn’t going to be making the list of equality issues campaigned on by the Equality and Human Rights Commission any time soon. But it could be an interesting programme nevertheless.

And it would be on the BBC. As penance for their decades of dextrism.

In 1967 the BBC test card for colour broadcasts was produced. It had a girl sitting playing naughts and crosses on a blackboard holding a piece of chalk in her right hand. Awww. Cute. Or a little eerie. But the girl was actually left-handed in real life, and the original photo had depicted her as such. A BBC executive demanded that the image was reversed as it was felt to be somehow “inappropriate” to show her as left-handed. 

Dextrist bastard.

Ottolenghi's NOPI restaurant

Vegetarian readers of the Saturday edition of The Guardian will likely have become intimately acquainted with Yotam Ottolenghi's complex recipes that reward with perfect flavour combination. And have in all likelihood bought up his collection of veggie recipes, Plenty. Well, I certainly did. It has, so far, proved capable of delivering superb food from every single recipe tried so far. The news that Ottolenghi was to open a restaurant, just north of Piccadilly in London - hence the name NOPI - led to the possibility of creative, diverse, exciting veggie food (along with meat and fish dishes) and led to a table reservation on the second weekend of March.

The first thing that greets you at NOPI (after a phone call 24 hours earlier to check you are still coming - a sign of a sold out restaurant?) is the brightness of the space it occupies. White everywhere, including lots of stylised tiling (I found this pleasingly clinical; my dinner partner felt it was a bit reminiscent of a bathroom – though the highly mirrored bathrooms themselves are something else). The whiteness is offset by huge brass light fittings and the light wood of the tables. Oh, and the big table with some massive loaves of bread and a big dish of a pinky substance.

The waiting staff seemed to embrace the relaxed atmosphere, open to chat about the restaurant, Ottolenghi and, of course, the food.

As we absorbed the menu, a complimentary dish of the pinky stuff - a beetroot and, I think, crème fraiche pate - arrived with slices of gorgeous bread, which were replaced as needed.

NOPI describes its food as sharing dishes. They are, though portions are not massive. Dishes also arrive as and when ready from the kitchen, so don’t be expecting to have it all there at once.

So, what was the food like? Honestly? It was some the best flavours I have ever tasted.

A grain-based dish combined braised artichoke and succulent broad beans with hits of tangy pickled lemon. A soft, creamy burrata was ably matched by explosions of blood orange and crushed coriander seeds. Mung beans became exciting when served with braised baby carrots and smoked labneh.

The lamb balls in a creamy sauce were evidently tender, though rich. And the beef dish was described as “possibly the best beef I’ve ever tasted” and certainly my partner’s highlight of the savoury courses.

For me, the highlight was the baked blu di bufala cheesecake. This warm cheesecake, almost soufflé-like in texture, was complemented by sharp pickled mushrooms; again, a perfect marrying of unconventional flavours.

The sweets on offer all sounded fabulous. But the chocolate, peanut brittle, mace and crème fraiche was a puzzling mix of ingredients that looked like they shouldn’t work together, but so do. And the churros served with hot chocolate sauce to dip into then coat with fennel seed sugar was both ludicrously sweet and utterly more-ish.

On the drinks side, we sampled a couple of the cocktails - the pineapple and sage martini being a particular favourite.

Downsides? In terms of the menu, I had none. The setting is relaxed and we did not feel rushed. Tables, though, are close together (which means that you can earwig in on neighbours who might, for example, include a vegetarian who eats scallops…)

I’m looking forward to my next meal there and seeing how the menu develops and changes and spending another couple of hours marvelling at Ottolenghi and his team.

Two rational ways to save the NHS money

The NHS is under the most vicious politically motivated attack it has seen in its lifetime. The level of cuts being made means no part of the NHS is immune to wholesale pruning, with some areas (e.g. experienced primary care commissioning) being destroyed to meet Andrew Lansley's blinkered mantra that the market can deliver more efficiency.

In the midst of such change it makes sense to me that rationality is applied to reforming aspects of the NHS and to making savings that are, at least, logical in terms of least impact on healthcare. 

This is exemplified by the current practice of applying clinical- and cost-effectiveness measures to proposed interventions. For example, if an expensive cancer drug (say £60,000 per round of treatment) is being touted as slowing down the advanced stages of liver cancer (say, by giving two weeks' extra life), should a patient on the NHS be able to get this? If I was the individual with the cancer, or had a loved one with the cancer, I’m sure my gut response would likely be "Of course - if there is a chance it will work then it should not be denied me." But, for an NHS with a finite budget, this response is not good enough and requires further scrutiny.

Firstly, is the intervention actually proven as clinically effective? Is it likely to have the positive impact the drug company claims? To answer this, the NHS needs to rely on real clinical evidence, ideally from randomised double-blind trials with significant numbers of people. "Rule of rescue" - the "we've tried everything else, so let's give this a shot too" is not a clinically sustainable rationale.

And secondly, even if an intervention is clinically proven as having positive impact, there remains another tough calculation that must be considered; the balancing of the health gain of that £60,000 spent on one individual with what else could be done with the same money in other treatments.  Seeking cost-effective treatments (and not spending on a clinically-proven but not cost-effective one) is something that our NHS does, and, for the most part, does well. It is potentially harrowing to take such decisions, but the NHS commissioners who do this are contributing to ensuring the NHS is the most effective in meeting the health needs of the whole population. As it should.

So, in the spirit of the coalition government's strap line "We're all in this together", I have a couple of suggestions of savings that could be quickly made to the NHS, and which would have zero impact on the health outcomes of anyone going through any part of the NHS.

The National Secular Society has just published a study into the money spent by the NHS on hospital chaplains: http://www.secularism.org.uk/uploads/nss-chaplaincy-report-2011.pdf It shows that the NHS could save £29m per year by stopping paying direct costs for chaplains. The study does not cost out the provision of rent-free office space, for example. So, if religions wanted to continue to provide chaplains, there is nothing stopping them doing so (they can visit, and could even continue to have rent free space). But the NHS should not be paying for them; the people who believe the particular set of myths relating to the faith group of that chaplain should.

It is not enough for believers to just claim that, for example, intercessory prayer works; where public money is involved, it is instructive to apply the clinical-effectiveness test to this NHS spend. The 2006  Study of the Therapeutic Effects of Intercessory Prayer (STEP) is the largest scientific study to date on the impact of prayer on health outcomes, involving over 1,800 patients. Its two key findings were:

1) “Intercessory prayer had no effect on recovery from surgery without complications.”

2) “Patients who knew they were receiving intercessory prayer fared worse.”

Or to put it another way, intercessory prayer is not proven to work.

 

This does not mean that it is "wrong" for people to pray for others. Indeed, those doing the praying are likely to report feeling better about the ill health of others, and, for those who believe and know they are being prayed for, they may take comfort from others’ praying. But this is not the same as a positive clinical output.

The STEP study is a robust randomised double-blind trial of the kind we demand from any other NHS spend. Well, almost any other.

In the UK another £4m could be saved every year by not spending NHS funds on homeopathy.  At a time when we are making significant cutbacks in clinically effective interventions, it beggars belief that we sanction the spend of £4m on a quack pseudo-remedy that consistently performs no better than placebo in double-blind trials. If an individual wants to spend their money on sugar pills and water, they can. But we should not spend public money in this way.

Like the religious, followers of homeopathy (once the pseudoscience of "water memory" has been debunked) resort to "it's about belief not science".

Until and unless we have an NHS with infinite funding, the provision of services through it should not be based on unproven belief systems, but through the same scientific rigor we apply to every other intervention.