TED Talks: Ben Goldacre on what doctors don’t know about the drugs they prescribe

A weekly post featuring talks by innovative thinkers, sponsored by TED (Technology, Entertainment, Design). This is what the internet was made for – to allow challenging ideas to escape from their academic ghettoes and hang out in a place where they can talk to each other.

Ben Goldacre is a doctor and a science writer who campaigns against bad science. In fact, Bad Science is the name of his column in the Guardian. In this talk, he reveals the alarming extent of confirmation bias in clinical trials, where journals are far more likely to publish positive studies, and negative studies don’t see the light of day. So even conscientious doctors like Goldacre sometimes find themselves prescribing dangerous drugs.

The Singing Detective: Who Done It (6/6)

The Singing Detective: Skin (1/6)
The Singing Detective: Heat (2/6)
The Singing Detective: Lovely Days (3/6)
The Singing Detective: Clues (4/6)
The Singing Detective: Pitter Patter (5/6)
YouTube: Skin (1/6), Heat (2/6), Lovely Days (3/6), Clues (4/6), Pitter Patter (5/6), Who Done It (6/6)
BBC Series

In last week’s episode, Philip Marlow (Michael Gambon) was closing in on the root causes of his psoriasis, with the help of his alter ago, the Singing Detective, a character from both his published novel of the same name, and a narrative constructed in his own mind. The childhood memories are getting deeper and more detailed.

He signs over the option for a screenplay of the The Singing Detective to Mark Finney’s (Patrick Malahide) production company, as a result of Nicola’s (Janet Suzman) seductive blandishments. But Marlow is deeply suspicious, creating a parallel mental narrative in which Nicola and Finney are lovers, plotting to conceal their ownership of the screenplay he wrote 10 years before, and for which Finney has claimed authorship. His revenge is to replace Sonia’s body, recovered from the Thames, with Nicola’s.

Marlow remembers an incident in Earls Court tube station, when his mum (Alison Steadman) discovers he already has psoriasis on his elbow, a result presumably of the mental anguish of watching her have sex with Raymond Binney (Patrick Malahide) in the woods, and his parent’s separation. So when he keeps talking about his dad (Jim Carter) joining them in London, she snaps and says it’s not going to happen. “Is it because of what that bloke did to you in the woods…Raymond Binney, Mark’s dad…Shagging!” And he runs away from her into the station, and along the ward where the adult Marlow can clearly see him.

That traumatic event could explain why, in his distress, he shits on the schoolteacher’s desk and blames Mark Binney, Raymond’s son. The obvious scapegoat. And that makes Mark Binney (Patrick Malahide) the perfect villain in The Singing Detective, a cover-up for Marlow’s own guilt, projected onto a fictional character.

By facing these memories, he becomes more powerful in his own narrative. The two Intelligence thugs fail to kill the Singing Detective at the Laguna, and he chases them off. They show up on the ward, but Nurse Mills (Joanne Whalley) confronts them, sends them packing, so they end up running through the Forest of Dean, with no clue about what they’re doing there or what their role is in the story. Characters in search of an author. “Are we going to be able to see the forest for the trees?” says the short rat-like one. “Here, I don’t think so,” replies the tall, fat one.

The last episode pulls it all together beautifully, ending with a spectacular finale that’s completely in keeping with a detective novel. It starts with breakthrough. Marlow tells Dr Gibbon (Bill Paterson) about returning to the Forest of Dean on the train after his mother commits suicide by jumping into the Thames – another element of The Singing Detective that owes its origin to Marlow’s biography. Although the body in the Thames becomes successively Sonia, Nicola, and finally his mum’s. The scarecrows, as they were on the journey to London, are threatening, and have his schoolteachers’s face. “She beat him, the poor boy. She beat him. Vicious bitch!”

He confesses to framing Mark Binney for the shitting on the schoolteacher’s desk, adding a few more damning details. A girl claimed to see Binney going back into the school and hear him talk about doing it. And most of the class piggyback on this lie until Binney, who is bit slow, believes it himself. Retelling the story in later years, Marlow finds out that Binney is now in an asylum. Marlow breaks down in tearful remorse for what he’s done. Dr Gibbon strikes while patient is penitent. “Stand up!…It’s now or never.” And Marlow stands up.

You can tell it’s a weight off his shoulders, because back in the ward he cheerfully greets everybody and insists on getting onto the bed under his own steam. “Yippee!”

There’s more to come. He imagines himself as an observer at Mark Finney’s flat as he and Nicola celebrate. The screenplay has been taken up by Hollywood, but Nicola is not cast in the film, the reason for her involvement with Finney. He doesn’t care. “Honey, don’t you think you’re just a teeny bit too old now?” Nicola’s fury is first directed at Finney. “You’re a killer!” Then she turns to look at Marlow. “You’re rotten with your own bile. You use your illness as a weapon against other people and as an excuse for not being properly human. You disgust me.”

The two Intelligence thugs are now back on Marlow’s track, as they discover the flat in a shambles, with Finney/Binney on the floor with a bread knife through his throat. They go off in search of Marlow, complaining bitterly that “we’re padding, like a couple of bleeding sofas!”

Marlow is back in the memory of meeting his dad at the station and walking home. His dad says, “I love you, Philip,” but Philip thinks the scarecrows will punish him for such confessions of love. He hides in a tree, until his dad trudges off, head down and emotionally devastated at this double betrayal, finally giving vent to wild cry of grief. Philip runs up to him and they walk off holding hands.

Marlow’s guilt at Nicola’s imagined words is kicked up to 11, when a policeman visits the ward to tell of Finney’s murder, Nicola’s arrest, and her subsequent suicide by jumping into the Thames. He wakes up, realising it’s a dream. “Nicola isn’t in the river!” So perhaps that whole affair between Nicola and Finny has just been another fiction.

By now, Marlow is getting up a pretty good head of steam, remembering more and more, and integrating his fantasies with reality. When he walks unaided down the ward, imagining Nicola there (“Hold onto me”) and telling him it’s not just about the illness. “Isn’t it about time you climbed down out of your tree?” Nurse Mills is furious because he’s doing too much too soon. That’s when our Intelligence thugs turn up to help put him back to bed, and it’s the beginning of the final breakthrough.

They want to know who they are – in other words, for Marlow to locate them in his psyche and do something with them. So they torture him – force his hands open, twist his feet, in a way that mimics cruel-to-be-kind physical therapy. Lurking outside the ward is the Singing Detective, who comes to his rescue, gun blazing. It’s a psychological shootout. At first, the patients and staff are oblivious to what’s going on. Then they start getting realistically shot until the whole ward is a mass crime scene. The Singing Detective has killed the short, mean thug, and the tall, fat one is standing by Marlow’s bed and begging for mercy. The Singing Detective does not kill him. Instead he puts a bullet through Marlow’s forehead.  “That was one sick fellow from way back when, and I think I’m man enough to tie my own shoelaces now.” Absolutely brilliant.

Next day, as he promised himself , Marlow walks out with his arm round Nicola. And it closes with young Philip up in his tree in the Forest of Dean, saying, “When I grow up, I be going to be a detective.”

So, happy ever after-ish. Maybe. But Marlow has reintegrated his personality round its strongest element, while lancing his repressed memories, properly expressing his guilt, and finding a new appreciation of other people. A superb psychological drama.

The Singing Detective: Pitter Patter (5/6)

The Singing Detective: Skin (1/6)
The Singing Detective: Heat (2/6)
The Singing Detective: Lovely Days (3/6)
The Singing Detective: Clues (4/6)
YouTube: Skin (1/6), Heat (2/6), Lovely Days (3/6), Clues (4/6), Pitter Patter (5/6)
BBC Series

I said last week that it looked as if Marlow (Michael Gambon), afflicted with crippling psoriasis, was ready to face his demons. And so he does. The divisions within his psyche – childhood memories, the internal screenplay based on his novel, The Singing Detective, and present reality – are beginning to merge together until he gets a glimpse of the psychological drivers of both his misogyny and chronic psoriasis.

At this moment I am a bear of very little brain. A blow by blow account of this episode seems pointless, given the beautiful, free-flowing nature of the narrative, and I don’t think I’m bringing anything to it by doing so. I just want to enjoy it, and hope you do as well. The YouTube link is at the top of the page for those without iPlayer, or those who live abroad.

Next week I’ll write an overall, wrap-up post for the whole series.

The Singing Detective: Clues (4/6)

The Singing Detective: Skin (1/6)
The Singing Detective: Heat (2/6)
The Singing Detective: Clues (3/6)
YouTube: Skin (1/6), Heat (2/6), Lovely Days (3/6) Clues (4/6)
BBC Series

Just because you’re paranoid, doesn’t mean people aren’t out to get you. This is the new element added in this week’s episode. Philip Marlow’s (Michael Gambon) suspicions about the root causes of his psoriasis, given fictional form in the Singing Detective, now have analogues in real life. If the character, Philip Marlow, in the television drama, The Singing Detective, written by Dennis Potter, can be considered real life. The Philip Marlow, that is, who is a hospital patient. I love the way Potter messes with our heads, nesting different levels of reality within the narrative, and sending us through the worm holes connecting realities in a way that subverts any hierarchies we try to construct.

In this case, he opens up a world outside the hospital and contemporaneous with it. This bubble of reality is Mark Finney’s (Patrick Malahide) flat on the Embankment, which is none other than Mark Binney’s (Patrick Malahide) flat in Marlow’s internal novel. And of course, Finney and Binney are played by the same actor.

Marlow’s wife, Nicola (Janet Suzman), visits him in hospital. I had assumed her participation in his recovery sprang from a desire to help, born out of residual affection for her husband. Apparently not. She wants him to write, can arrange for a side ward where he will be quiet, and someone to take dictation. But she doesn’t want him writing the novel in his head that’s helping the Singing Detective to ferret out the clues pointing to the root cause of his psoriasis. Instead, “Write about reality in a realistic way.” “All solutions and no clues,” sneers Marlow.

There’s a reason behind this. Marlow has received an offer to write a screenplay for a film of the The Singing Detective, his published novel. He tells her that he wrote a screenplay years before, but she pretends not to remember. And he’s already writing a novel in his head. Marlow is deeply suspicious of her involvement. He’s right to be. Nicola has intercepted the film offer and her lover, Mark Finney, has presented the old screenplay as his own work. But they need him to start writing again, and it’s Nicola’s job to persuade him. She fails this time, as Marlow sends her out of the ward with another stream of verbal abuse. I confess to not quite understanding why they want him to write, if it’s to be about “real life” and not as some contribution to the screenplay they’ve stolen.

That’s worrying Finney. Time is clearly of the essence. The other thing worrying him is that Marlow’s script from years ago has the Binney character living in his flat and with only a change from “F” to “B” in the name. Furthermore, it seems to change the plot of The Singing Detective (the novel) to reflect their plot against him. “I almost feel as though he’s made all this up.” Indeed, Marlow is writing the script for Nicola as she leaves the ward and meets Finney in the waiting room.

Meanwhile, the clues are becoming more tangible. It’s very clear that Marlow has a deep, existential guilt springing from his childhood. The earlier episodes gave a hint, but in those cases it really wasn’t his fault that his parents split up. Their wildly different expectations of him could be expected to produce psychological trauma. This time it’s something he did, or so I surmise from his treetop bargaining session with God, where he says, “Please God, I didn’t mean to do it.”

Someone has dropped a turd on his teacher’s desk. She leaves it in situ, then terrorizes the class with visions of a vengeful God who knows all their evil little thoughts – “He is going to point his Holy finger.” This woman is a world-class champion sadist. When she sees Philip crying, he’s called up to the front to confess, but will only concede that he knows who did it. So, under threat of an endless caning from the headmaster, Philip is told to stand stock still, eyes focused on both the cane and the turd, until he names the culprit. After seeing another child caned, merely for not paying attention, he  says it was Mark Binney.

These scenes are interwoven with the appearance of a group of evangelical Christians on the ward, led by the risibly named and humourless Dr Finlay, who sing hymns.

It’s also interwoven with his internal novel. Earlier, the Singing Detective waited for HMS Amanda outside Skinskapes. When she emerges, he calls out from the shadows, “Achtung, Amanda.” She turns, the implication being that she knows Skinskapes is a front for processing Nazi rocket scientists to America. So the Singing Detective follows and discovers where she lives. But the two hoods at Skinskapes shoot her before he can make contact.

Now the Singing Detective is on stage at the Laguna Palais de Dance, singing Accentuate the Positive, while the two hoods from Skinskapes are waiting for the end of the set so they can kill him. Then the scene merges into the Jesus Freaks on the ward singing the same song and gathering round his bed like avenging angels. Here’s the video clip.

A shitload of guilt. It sounds like Marlow is ready to face his demons. I think he said, right after the evangelical assault, “Lord, let it come on.” And another short phrase I couldn’t catch.

The Singing Detective: Lovely Days (3/6)

The Singing Detective: Skin (1/6)
The Singing Detective: Heat (2/6)
YouTube: Skin (1/6), Heat (2/6), Lovely Days (3/6)
BBC Series

Philip Marlow (Michael Gambon) writer of pulp detective stories, is unwillingly digging deeper into the psychological reasons for his crippling psoriasis, and finding all sorts of painful memories. Coincidentally, as no doubt his conscious persona would insist, the disease has retreated from the terminal phase he was in at the end of last week’s episode. He’s able to turn his head almost normally, even if he has to be tricked into it by Dr Gibbon (Bill Paterson) pacing about behind his back and saying, “You know about bats?” to elicit an angry response. It’s in the context of Gibbon pointing out the scary creatures a man hiding from life inside his illness might be expected to find. Marlow can also now reach over to the bedside table pick up his cigarettes, fumble one into his mouth, and light it.

Marlow is beginning to piece the puzzle together in those three levels of his psyche that are working on finding out whodunnit. Each one is bleeding into the others and creating mental feedback loops, so he jumps from state to state, learning a little more each time.

His memories of childhood, when was 10 and everything changed, have taken on a threatening sexual overcast. When his mum (Alison Steadman) leaves his dad (Jim Carter), and takes Philip with her, it’s in a steam train whistling and pumping smoke, diving through tunnels. The carriage is full of lecherous soldiery, ogling her legs and a fringe of white, exposed slip. His mum hides behind a newspaper that talks of the imminent end of the war, refusing to wave goodbye, as Philip does from the window, until his dad is lost to sight. He can’t understand why they’re leaving or why he can’t come with them. Philip blames himself: “Summat’s wrong. Summat’s bloody wrong, mind…Is it my fault? Have I done it again?”

But there are are deeper memories that make this train journey so hellish. He has seen his mother sloping off into the woods to have sex with Raymond, another villager, and followed them to watch. He has learned cruelty along with the distress, smashing a ladybird to pulp with the words, “Can’t abide things that creep and crawl.” And he’s seen his mother crying with the guilt she feels, wondering whether to get his dad to help.

This Raymond is an utter bastard, singing duets in the working men’s club with his dad, and touching his mum’s shoulder with an easy familiarity as she plays the piano. The audience know what’s going on, turning to laugh mockingly at him as he replays the scene in his mind. Only his dad hasn’t worked it out. Though perhaps he has.

It shouldn’t be like this. The schoolteacher keeps them up to date with the triumphal progress of the war, and promises a future most are too young to remember – lights on everywhere at night, church bells, fireworks and a glorious tomorrow. She gets them to sing, “It’s a Lovely Day Tomorrow,” because now, finally, after 6 years of war and privation, it will be.

But not for Philip, trapped in a railway carriage with his mum being leered at by the soldiers, and lashing out at the one who offers her a handkerchief as she breaks down in tears. So it’s not surprising that in his confusion he threatens to tell his dad and “the man in the woods.” And not surprising that after a visit to his grandparents’ house in London, where his mum sings under her breath to a record of Lili Marleen, that he runs away from her in the Tube.

Mrs Marlow also finds her way into his inner detective story as an NKVD spy masquerading as a blonde prostitute at Skinskapes. She’s watching the outside of Mark Binney’s (Patrick Malahide) flat by the river, where the Singing Detective is reporting a lack of progress – vamping, as in tooling around with an incidental tune until the real song starts. He spots Lili outside and confronts Binney with the accusation that he earns his money by helping influential Nazis evade capture. Binney pays him off and tells him to get out. Incidentally, Raymond and Binney are played by the same actor, a measure of Marlow’s subconscious contempt for the man.

When Lili tries to speak to the Singing Detective outside the flat, he tells her not follow and meet him later, knowing they will be watched. But she does follow, and is shot by the two gansgters who work for Skinskapes, telling him before dying that the club is a front for hiding Nazi rocket engineers. Lili becomes Mrs Marlow for a moment, brushing his face with her hand as if he were the young Philip. The Singing Detective/Marlow is moved to rage and a determination to find out who’s responsible, not just for the murder but for his own mental and physical predicament. “I’ll get you, whoever you are, whatever you are, wherever you are,” he says, “I’ll get you!”

Back on the ward, Marlow has killed another patient. Not really, but as he says to Nurse Mills, “There’s a curse on that bed.” The old man who has taken Ali’s place wants Marlow to give him a cigarette. He refuses because he can’t throw and can’t get out of bed. The old man starts to reminisce about buying German girls for sex during the war for two cigarettes. He gets over-excited and has a heart attack, while Marlow, disgusted, taunts him. Then he realizes what’s actually happening and calls for help. The noise of the respirator, as the nurses try to revive the old man behind the closed curtains, are conflated in his mind with the sound of his mum and Raymond having sex in the woods.

Then it’s time for another greasing with Nurse Mills (Joanne Whalley), and Marlow disgraces himself again when she lifts his penis, despite trying to think of a long list of boring 80s topics to take his mind off it. Strangely enough, there was one that might be making a comeback – “yomping across the Falklands.” We can only hope not. Marlowe’s final recourse is to the detective story, but unfortunately the Singing Detective walks past the portrait of his half-naked wife on Binney’s staircase. All his efforts at self-control are to no avail and Nurse Mills is disappointed in him.

So Marlow is getting there, with the the help of Dr Gibbon, Nurse Mills, and his wife, Nicola (Janet Suzman). Despite Marlow denying the fact of their marriage, she is apparently working behind the scenes to try to get him a side ward and someone to take dictation, so he can continue writing the detective story of his own life. One measure of his improvement is that Dr Gibbon, who he despised to begin with, now reminds him only half-cynically of his old schoolteacher. The one who led the class in singing, “It’s A Lovely Day Tomorrow.”

The Singing Detective: Heat (2/6)

The Singing Detective: Skin (1/6)
The Singing Detective: Lovely Days (3/6)
YouTube: Skin (1/6), Heat (2/6) Lovely Days (3/6)
BBC Series

Philip Marlow (Michael Gambon) suffers from an extreme and debilitating form of psoriasisDennis Potter’s classic musical drama, The Singing Detective, is a psychological detective story, hot on the trail for clues to what’s really under Marlow’s skin. They are, of course, to be found hidden in the detective story he’s obsessively creating within his own mind. And in the hallucinations and memories of his childhood in the Forest of Dean, all these sources feeding on each other to ramp up the revelations he’s confronted with.

Marlow’s alter ego within the detective story is the Singing Detective, a thoroughly Chandleresque character in trench coat and mustache. He really is a singer, fronting a band in a dance hall, as well as being a detective. You can see where he gets it from, too, as the flashbacks of his father singing at a working man’s club show. He is also thoroughly misogynistic, a point raised by the psychiatrist, Dr Gibbon (Bill Paterson), who Marlow reluctantly agrees to see.  His pretense is that it gets him off the ward. Gibbon looks for and finds the clues in Marlow’s book, The Singing Detective, while Marlow’s own internal novelistic psycho-drama reveals them in plenty.

It turns out that when Mark Binney (Patrick Malahide) got into the taxi last week with HMS Amanda and HMS Sonia from Leningrad, it was actually Sonia who completed the journey to Binney’s flat. Not surprisingly, as Marlow’s creation, Binney is equally misogynistic, treating her with contempt, which she returns with interest. Insisting on the money up-front, she rips it up, stuffs it in her mouth, and spits it on the floor at his feet. Only then does she go to bed with him. As soon as he’s finished, Binney gets out of bed to light a Groucho Marx size cigar, suggesting that Marlow doesn’t much like sex, either, as Dr Gibbon also surmises from the novel.

It’s then that he notices two men in trench coats, obvious gangster types, lurking outside and watching his window. They were at Skinscapes, as well, and the same actors play a pair of furtive characters in the flashback scene at the working men’s club. Sonia is immediately alarmed and tries to get away, fueling Binney’s suspicions. He’s been trying to find out what she really wants all evening and suspects her to be an NKVD agent, while he was in the Intelligence Corps during the war. When Binney tries to stop her leaving, she head-buts him, making his nose bleed, and escapes.

Binney then hires the Singing Detective, because when Sonia goes missing, he immediately comes under suspicion. Here’s where the internal novel’s time frame is narrowed down to a few months after the end of the war, 1945 or early 1946. The Singing Detective is suspicious of his client, and so he should, since he/it are another devious part of his personality with secrets of their own. Binney is then visited by the two gangsters, who tell him the police have discovered Sonia’s body and they really need to talk.

Marlow’s memories, and the reality of his life on the ward are interleaved with scenes from the internal novel, making the sometimes explosive connections between more powerful. He returns to the Forest of Dean as an intelligent 10 year old boy, torn between the comfortable traditions of his working class father and the social aspirations of his middle class mother. It doesn’t help that they live with his grandparents – they think she’s a snob, she thinks they’re not good enough. In the scene around table, when he’s late for tea, you could cut the atmosphere with a bread knife. Philip’s grandmother orders his mother out of the house after unforgivable words are spoken. Here’s one well-spring of the guilt that’s under the skin of his psoriasis. He says to himself, “It’s me, me, it’s all my doing.”

So poor Philip is left to cleave desperately to his father’s working class culture and strive to be the cleverest boy in school to please his mother. At the working men’s club, his father sings It Might As Well Be Spring, accompanied on the piano by his mother. Everyone is moved, rapt with the emotion roused by the song. The bond between father and son is strong at that point. Then his mother plays a tinkly classical piece and the spell over the audience is broken. Father and son exchange guilty, rueful glances.

But young Philip isn’t liked by his contemporaries. A couple having sex in the forest see him watching and jeeringly invite him to join in. As he runs away, the other children emerge from the underbrush like avenging spirits and taunt him with “Clever Dick, clever dick, makes me sick.” It looks like a trap, perhaps knowing Philip’s curiosity.

Ali’s replacement in the bed next to Marlow’s is an elderly man sliding into Alzheimer’s, gratefully deposited by his wife, after what sounds like a history of physical abuse. So he has no friend on the ward except Nurse Mills (Joanne Whalley).

Marlow is also getting physically worse, his temperature rising dangerously. He has a flashback to the working men’s club, listening to his father trilling a cuckoo’s song. He’s very happy, sitting at a table in the back of the hall with his crisps and a drink. But he’s unable to applaud because suddenly it’s Marlow now, the patient with arthritic fists for hands. Worse still, a bystander is telling him that he never appreciated his father when he was alive. The revelation that his father is dead devastates Marlow in this in between world of memory and dream. The hall becomes an empty, abandoned hut with only his table there at the back. And Marlow realizes his loss and guilt: “I have so much to say to him. I need to speak to him very badly. But it’s too late. He can’t be dead, not my dad.”

He wakes up barely able to speak, with the disease “at its absolute peak now. It’s 100%.” But Potter’s too good a writer to let us go with something that can construed as sentimentality. Marlow’s wife (Janet Suzman) arrives, the very wife that he denied having to Dr Gibbon. During the last scene in the internal novel, the gangsters make leering remarks about a portrait on Binney’s wall. It’s of a woman, naked from the waist up, and they call her a “slut.” Nicola is that woman brought to life. She’s bitter and squeamish, shying away from his ruined body in the bed, only really there to speak to the doctors. Instead she leaves, unwilling to endure his anger. But Marlow knows she’s there, and calls out for her, “Farewell my lovely…come back you bitch.” Then he launches into a torrent of vile abuse at her departing back as the other visitors gape in shock at the outburst.

So this is the crisis. Marlow has nowhere to go but into himself to find a way out.