God’s management consultants: the Church of England turns to bankers for salvation

Justin Welby wants to focus on growth – and has City high-flyers on hand to help him do it. Can he take his fractious Church with him?

This article was published in The Spectator.

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A new mood has taken hold of Lambeth Palace. Officials call it urgency; critics say it is panic. The Church of England, the thinking goes, is about to shrink rapidly, even vanish in some areas, unless urgent action is taken. This action, laid out in a flurry of high-level reports, amounts to the biggest institutional shake-up since the 1990s. Red tape is to be cut, processes streamlined, resources optimised. Targets have been set. The Church is ill — and business management is going to cure it.

Reformers say they are only removing obstacles that hinder the Church from growing. Opponents, appalled by the business-speak of some of the reports, object to what they see as a ruthless focus on filling pews.

Two reforms in particular have generated headlines. One is the plan to swipe £100 million from the Church’s investments to pay for more priests (target: a 50 per cent increase in trainee clergy by 2020). The other is to give business-school training to bishops and deans and, more controversially, to identify a ‘talent pool’ of future leaders — in the official language, people ‘with exceptional strategic leadership potential for Gospel, Kingdom and Church impact’.

Provoking more anxiety, though, is the emphasis on growth in numbers. Half of the central fund distributed to help poorer dioceses is to be diverted to support thriving projects. The previous system was thought to ‘subsidise decline’. The new approach, to be brought in over ten years, is meant to ‘incentivise… Church growth and innovation and flexibility’.

To many in the Church this feels like new ground. The C of E, they say, should be focused on God, not growth. The Revd Canon Professor Martyn Percy, dean of Christ Church, Oxford, says he has received hundreds of emails and letters from people worried by all the talk about ‘efficiency, success, targets and data’. Jesus, he says, ‘didn’t spend a lot of time going about success’.

Such unease is only likely to be heightened by the involvement of high-flying City execs. One report was written by Lord Green, ex-chairman of HSBC; another by John Spence, former chief executive of LloydsTSB Scotland. A third refers to a working session, requested by the Archbishop of Canterbury, Justin Welby, with executives at Lloyds Bank. (Success, Church officials were told, ‘requires focus, determination, organisation and adequate resourcing’.)

Read the rest of the article here.

Meet the medical experts who will be guiding Spectator Health online

This article was published by Spectator Health on 19 February 2016.

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The media’s coverage of health matters. It affects what foods we buy, what pills we take, whether or not we get our children vaccinated. Yet health reporting is confusing at the best of times. Sometimes the experts don’t agree. More often, the media goes with a fresh angle because it is interesting, and the true picture is obscured.

These days it’s not just the journalists who get blamed. The new scapegoat is the university press office, which can hype up research in a way that distorts the actual findings.

That’s why Spectator Health has assembled a panel of medical experts to cut through dodgy press releases and offer a reliable verdict about the value and robustness of each piece of research that we report on.

Our reports (as in today’s here) will contain a ‘sniff test’ from one of our medical experts which will point out if the conclusion is new, long established or obviously wrong, and, if relevant, draw attention to more robust research in the same area. Each paper will get a score out of five — zero for meaningless PR guff, five for gold-standard research.

The medics and academics who are lending their expertise are GPs Dr Chris Hall, Dr Roger Henderson, Dr Michael Banna and Dr Ryan Maginn, cardiology registrar Dr David Warriner, cardiologist Prof Robin Choudhury, obstetrician-gynaecologist Dr Tarek S Arab and pharmacologist Prof David Colquhoun — all of whom can spot a dodgy Daily Mail headline from a mile off.

That way we can combine the virtues of good journalism with proper medical rigour. And, the next time you are baffled by claims that beetroot juice prevents dementia or that bacon will give you cancer, you know where to find a bit of sense.

Does a tan really raise your risk of skin cancer?

This article was published at Spectator Health on 12 February 2016.

‘No safe way to suntan, new NICE guidance warns.’ The BBC headline was repeated by most of the media and reflected some alarming new advice on skin cancer. The nub of it was that people should expose their arms and legs to short busts of sunlight only — long enough to get a hit of vitamin D, but not long enough to change the colour of your skin.

The guidelines aren’t based on any new evidence and don’t represent a change in thinking. Instead they are an attempt to reflect current consensus among the experts. I have to admit I was shocked that a bit of sunbathing is actually considered risky behaviour. But is it true — and how much does it raise your risk of skin cancer?

The truth is the experts don’t know. The clear evidence relates to sunburn, not tanning. A meta-analysis published in the Annals of Epidemiology in 2008 found that getting a painful sunburn every two years of your life triples your chance of a melanoma.

Another study found that if you had 26 or more ‘painful’ or ‘severe’ sunburns in your lifetime your risk would double or triple.

To put this into perspective, the lifetime risk of developing a malignant melanoma is one in 52 for men and one in 54 for women.

As a rough estimate, then, getting sunburnt frequently will raise your risk to slightly less than three in 52 (for men) or slightly less than three in 54 (for women) — slightly less, that is, because the original lifetime risk figures encompass everyone, including the perennially sunburnt, so to simply triple the figure would be to overstate the risk.

Another key factor is your skin type. People with very fair skin (classed as ‘type 1’) have double the risk of a melanoma compared to people with dark skin (‘type 6’).

When it comes to skin cancer risk and tanning, the picture is hideously complex. Many skin cancers are caused by exposure to ultraviolet light (either through sunshine or sun beds). Ultraviolet light also causes skin to darken. So a tan is evidence of exposure to a carcinogen — it is the skin ‘trying to protect itself’. But that’s a good thing, too: a tan will protect against future exposure to UV. That is why people with naturally dark skin are at lower risk. There is some evidence that outdoor workers, who spend a lifetime in the sun, are at lower risk too.

Mark Elwood, professor of cancer epidemiology at the University of Auckland, explained:

Epidemiological evidence shows that ‘intermittent sun exposure (from holidays, etc) is more of a risk factor for most melanoma than continuous sun exposure (from long-term outdoor employment): maybe in the latter situation, the protective mechanisms outweigh the initial carcinogenic dose.

He stressed that, for most people, these ‘protective mechanisms’ will not apply, and the NICE guidance is ‘probably a reasonable, if over-simplified, statement’.

Can genetically modified ‘killer mosquitoes’ stop the Zika virus?

This article was published at Spectator Health on 26 January 2016.

The forecast for the Zika virus outbreak seems dire. There is no vaccine, and no hope of one for at least a year, probably longer. And, according to the World Health Organisation, it is likely to spread to every country in the Americas apart from Canada and Chile.

Women in El Salvador have already been told to leave off getting pregnant until 2018, as it seems likely the virus causes brain damage in infants. Of course, this does not seem very realistic.

While North and South Americans wait for a vaccine, the best hope may lie in targeting the Zika carriers: the mosquitoes. And scientists in Oxford have developed an extraordinarily deadly means of doing so.

A company called Oxitec, set up by scientists from Oxford University, has produced a form of genetically modified mosquito whose offspring do not survive. By releasing millions of these GM males into an area to mate with potentially virus-carrying females they can lower the mosquito population by nine-tenths in a matter of months. (The GM males die quickly too, having been programmed to survive on a special diet in a lab.)

Trials on the Aedes aegypti mosquito — the mosquito transmitting the Zika virus – have already been carried out in Brazil. The target of the trial was not Zika, but dengue fever, and in Eldorado, Sao Paolo, where the GM mosquitoes were released, the number of dengue cases dropped from 133 to just one in a year.

The Oxitec mosquitoes are still being reviewed by the US Food and Drug Administration and a plan to use them in Florida met fierce opposition following headlines about ‘genetically modified killer mosquitoes’.

If taken up by the governments of the Americas they could be a key weapon against the Zika virus, alongside more routine methods of mosquito-avoidance. The challenge will be to scale up their production quickly enough to make a difference.

In the longer term they may well be crucial in efforts to combat other mosquito-borne disease — dengue fever, chikungunya, yellow fever, malaria — by keeping the mosquito population at a very low level. It tentatively raises hopes that the mosquito may one day no longer be such a deadly enemy for humans.

Type-2 diabetes has a secret: it’s perfectly reversible

This article was published at Spectator Health on 6 January 2016.

Carlos Cervantes used to suffer from severe diabetes. His low point was 2011, when he had a heart attack, his kidneys started failing him and he was facing a foot amputation because of a toe-to-ankle ulcer. ‘I had pretty much figured that my time was up,’ he says.

Then he stumbled on a news clip about a study at Newcastle University. In it all 11 subjects had their type-2 diabetes reversed after following a very low-calorie diet — that is, just 600 calories a day for eight weeks. So Cervantes gave the diet a try. His blood sugar dropped to a normal level, his symptoms vanished and he was returned to good health.

The mechanism is simple. Type-2 diabetes is caused by a build-up of fat stopping the pancreas from producing the insulin we need. Restricting calories to a very low level means we can burn off this fat, allowing the pancreas to start working normally again.

Cervantes’s success story is one of many. Professor Roy Taylor, who led the Newcastle trial, says ‘over 100’ people around the world have contacted him to say they have tried the diet and got rid of their own type-2 diabetes.

Now, together, with Professor Mike Lean, he is leading a five-year study to determine whether such a diet might become routine NHS treatment (for type-2 diabetes, but not for type-1, which is caused by a reaction of the immune system, not fat). The results will begin to trickle in next year and be published in 2018.

Official guidelines may change after that. Until then, there’s nothing to stop people trying the diet themselves (though if you are on medication it’s best to check with a doctor first).

Fortunately, you don’t have to drop down to 600 calories a day. Subjects in the latest trial have a daily intake of 800. This seems to make a big difference. The earlier trial was gruelling. The journalist Richard Doughty, a subject on the trial, recalled feeling tired, hungry, and ‘detached from colleagues’. Even though it was July his fingertips went white with cold and he had to wear a coat.

On 800 calories it’s not nearly so horrible. ‘The first 24 or 48 hours are tough,’ says Professor Taylor. But then the body adjusts and ‘you rapidly lose the sensation of hunger’. In fact, he says, most of the subjects so far have carried on with the diet for longer than the 12-week minimum.

But, from the point of view of burning fat, 800 calories works as well as 600 — both are well below the daily requirement of 2,500 (men) or 2,000 (women). On either diet we get most of our energy from our fat rather than the calories we consume.

One problem, according to Taylor, is boredom. The diet involves nothing but nutritional shakes and water for 12 weeks. The shakes, made by Cambridge Weight Plan, don’t come in all that many varieties. (An alternative 700-calorie diet that includes actual food can be found here.)

Another issue is you can always put the weight back on. You might reverse the diabetes only for it to come back later. ‘One of the most difficult things is not getting the weight down, but adapting long-term habits,’ says Taylor.

Type-2 diabetes is still widely seen as a progressive condition that will only ever get worse. One biscuit too many, you think, and you are doomed. The good news is there is a way out and it doesn’t even involve a pill or a doctor — just a diet.