The one certainty in life is death. We come into this world with nothing and we leave with nothing. Our predecessors were aware of this only too well. War, famine, pestilence and death have stalked us since time began. No wonder the four horsemen are such powerful and terrifying icons. One of the commonest graveyard epitaphs of Victorian England was "in the midst of life there is death". All very depressing. But the risk of death is still 100% for all of us, I'm afraid.
Happily, we're now in the 21st century – technology has conquered everything, surely. Miracle drugs for cancer, HIV, heart disease – a pill for every ill. We even have pills to make us thin, happy, less forgetful and to enjoy better sex. If we want to look younger, then plastic surgery and Botox is on hand. Technology and innovation seem to have vanquished death. But they come with a hefty price tag, as the NHS is finding out, especially as we get older and accumulate problems. They also have severe limitations.
We live in a fiercely self-centred, consumer-driven global society where the internet provides solutions for all our needs. We are obsessed with a celebrity culture full of trivia. How can a simple influenza virus wreak such psychological havoc in modern Britain and why are we so afraid? After all, as of yesterday, only 26 people had died from swine flu in England, far fewer than in road accidents over the same period. It's all about our changing perception of risk. But let's get some perspective. Every single day, 6,000 children die in the world from dehydration due to diarrhoeal disease. A huge personal tragedy, preventable for less than the price of a bottle of wine or a pack of cigarettes, but do we care? Seemingly not – it's happening far away.
I began learning medicine more than 40 years ago. Today's society is so very different. Traditional hierarchies have disappeared. Today, more people live together sometimes transiently as partners, there is a much higher divorce rate and widespread international mobility among the young has made family structures far less cohesive. Organised religion is a much less important component in people's lives. Faith in a superior being is a powerful antidote to fear, giving life purpose and destiny. Yet a vacuum has replaced our spirituality in western society. Without faith, perceived risk is amplified beyond all recognition.
Health risk is a strange business. As the great feminist writer Susan Sontag pointed out, we all carry two passports – one for the kingdom of the well and other for the kingdom of the sick. We don't choose which one we will use at any time. When you become ill from a heart attack, cancer or even influenza, you start down a road you've never travelled – a diversion whose destination is uncertain. Health professionals convey risk in different ways with different levels of skill.
As a medical student in a previous flu epidemic, I vividly remember working on a ward full of men on ventilators. We just ran round doing the best we could. The doctor in charge, a bright Indian registrar, had a simple strategy to convey risk. He gave all the relatives a very gloomy prognosis indeed. Once you've been told the worst possible outcome, you regard anything better as a bonus. Most patients actually recovered and they and their families loved us all.
Like my registrar, today's media have used the same strategy. Scary stories sell papers. And if there's a bit of conspiracy about incompetent governments, corruption over access to drugs that don't really do very much anyway, police as agents of the state imposing compulsory quarantine and check-in agents officiously banning passengers from boarding aircraft, it's even better. The facts are simply forgotten in the hysteria.
The best website is that of the UK Health Protection Agency (www.hpa.org.uk). It should win an award for clarity and truthful excellence – a beacon in a sea of chaos. The easy-to-follow graphics show that we are clearly in the midst of a pandemic. We don't know how and when it will end or how bad it will be and that's the problem. Doctors from the director of the WHO and our chief medical officer down to the brightest new graduate simply have no idea. There could be 3,000 deaths by Christmas or 65,000. But it will eventually burn out. It's living with the uncertainty of how it will affect us that we find difficult.
Swine flu has become a modern plague – a 21st-century version of the black death that wiped out a third of Europeans more than 600 years ago. It's a great story for the media. The uncertainty, the contradictory advice, the blame, compulsory quarantine, stranded travellers rejected by the world's favourite airline. And the clumsy, state-run apparatus for restricting freedom of individuals in a haphazard manner as though flu victims were common criminals is just so inappropriate.
Imagine the Derbyshire village of Eyam in the 17th century. The plague had struck. Nobody left the town, as they realised they could pass the disease on. Surrounding villagers brought food and left it on a stone in the middle of a field, which is still there today. Intriguingly, coins were left to pay for the food in a hole in the stone sterilised with vinegar at a time long before bacteria were discovered. What perception from people who had almost no education. And an amazing story of selflessness, sacrifice with voluntary co-ordinated action for the greater good. Would we do this today? Of course not. The villagers would be coughing and spluttering in the aisles of the nearest supermarket, stripping the shelves of Tamiflu if they could.
When our own mortality is suddenly questioned, we need to have a shoulder to lean on. If we have no family infrastructure or belief, what is there? A plethora of anonymous helplines, websites with names such as Fluline, the National Pandemic Flu Service and NHS24, together with drop-in centres staffed by bored-looking nurses don't really provide the reassurance of the most famous television GPs of all time – Dr Finlay and his senior partner, Dr Cameron. They knew their patients as people; they were fully integrated into their society. We badly need them to return. Indeed, the BMA last week compiled a list of 343 retired GPs who are being granted special registration to let them come back to deal with the current crisis. Maybe there's hope.
What will be the legacy of swine flu? I hope a better understanding of risks and how society can mitigate them. New health challenges are inevitable. What will they be? A new cancer-causing virus, a mutated HIV virus that can be transmitted by droplets in the air, a food component that leaves us riddled with a severe degenerative disease or a form of radiation that insidiously causes congenital mutations? The possibilities are endless. Life is just such a risky business.
Dr Karol Sikora is dean of the University of Buckingham's medical school
