Holey private: dreams of health for loadsamoney. Photo: BBC
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Theatres of the absurd: the unadulterated horror of Harley Street

Six months of treatment for cancer? A mere £30,000 at London's most exclusive clinics.

Inside Harley Street
BBC2

Don’t be misled by the outwardly jaunty tone: in her new films about Harley Street (Mondays, 9pm), the documentary-maker Vanessa Engle has opened a vein of unadulterated horror. How desperate people are, and how deluded. I suppose we all know that human beings will cough up almost any amount of cash in pursuit of hope. But it’s surprising and rather devastating to find that they also write vast cheques in exchange for hugs, handshakes and empty blandishments. “You look great!” trills a plastic surgeon to her seventysomething-year-old patient as she arrives at her consulting room post-facelift, looking like something out of a Channel 4 drama about domestic violence. Beneath her gaze, the patient, bruised and battered, blooms like a flower. It seems not to occur to her that the doctor is merely praising her own (very expensive) handiwork.

Engle (Jews, Women, Welcome to the World of Weight Loss) has a satirical eye and is known for asking her interviewees blunt questions (“What’s your worst fear? That he might die from cancer?”). But what I like best about her technique is her swift, minimalist way with folly. So deftly does she lay it out – she is the surgeon here – that we’ve no option but to fall into line in the matter of judgement. Will a hair transplant change a young man’s life? It seems unlikely, and perhaps his mother is weeping because she already knows that it won’t. Will a husband appreciate, or even notice, his wife’s umpteenth cosmetic procedure? Well, anything for a quiet life; but no. Is it really possible to believe that, as a doctor, you were put on the earth to perform liposuction on sad young women? Definitely not, for all that you might well have a carefully prepared line about making people “feel” better.

Engle’s series is in three parts. The first film focuses on those who visit Harley Street because they are sick and the doctors who treat them. The second (airs 20 April) is about plastic surgery (I watched a preview because once I’d seen the first film I couldn’t bear not to). The third is about complementary therapies (ditto). The last two films are, I think, better than the first, and you should certainly try to catch them; I can’t remember a bit of observational TV that made me feel more disapprovingly Protestant, feminist and, above all, rationalist. But the first film had its moments, too. I do see that if you have cancer, and enough money, you might want to opt out of the NHS. Then again, if the highly qualified professional I was paying hundreds of quid an hour addressed my mother with the words “Hello, Mum!” I think my fear would temporarily shade into indignation. Equally mystifying was the young woman who wanted to be treated for breast cancer by the same clinic that had cared for her father. She wanted, she said, to share the same cancer “journey”. This dear dad, by the way, had since died.

The sums involved made your eyes pop. Six months of treatment for cancer? A mere £30,000. I tried to unpick the complicated mathematics of risk, faith and profit, but it was tricky. All the doctors involved confessed to having private insurance. Then again, the leading urologist Professor Roger Kirby admitted that the NHS had the same equipment as his clinic; the difference is that he offers a more personalised service (for instance: making the effort to learn the Norwegian word for “cured” while treating a patient from Oslo). How did they feel about working in the private sector? Not too conflicted, I would say. Only one, Professor Justin Stebbing, who runs a cancer research unit in the NHS alongside his Harley Street practice, said it sat “badly” with him.

And how did the patients feel about handing over their credit cards? Pretty good. One woman, pterodactyl-like behind glasses as big as television screens, had no idea how much her medical bills came to. “This is like asking Cameron how much a bottle of milk is,” she said, en route to her Bentley. Still, in the matter of serious illness (as opposed to the chap who rings his private GP at 2am and demands to have his blood pressure checked on returning from the casino), pity usually trumps politics, or so I find. Save your outrage for the next two films, which are Engle at her very best – and that’s really saying something.

Rachel Cooke trained as a reporter on The Sunday Times. She is now a writer at The Observer. In the 2006 British Press Awards, she was named Interviewer of the Year.

This article first appeared in the 17 April 2015 issue of the New Statesman, The Election Special

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High explosive, damp squibs: the history of bombing raids

Governing from the Skies by Thomas Hippler examines the changing role of aerial bombing.

Bombing from the air is about a hundred years old. As a strategic option, it eroded the distinction between combatants and non-combatants: it was, Thomas Hippler argues in his thought-provoking history of the bombing century, the quintessential weapon of total war. Civilian populations supported war efforts in myriad ways, and so, total-war theorists argued, they were a legitimate object of attack. Bombing might bring about the collapse of the enemy’s war economy, or create a sociopolitical crisis so severe that the bombed government would give up. Despite efforts to protect non-combatants under international law, civilian immunity has been and continues to be little more than an ideal.

Hippler is less concerned with the military side of bombing, and has little to say about the development of air technology, which, some would insist, has defined the nature and limits of bombing. His concern is with the political dividends that bombing was supposed to yield by undermining social cohesion and/or the general willingness to continue a war.

The model for this political conception of bombing was the colonial air policing practised principally by the British between the world wars. Hippler observes that the willingness to use air power to compel rebel “tribesmen” in Afghanistan, Iraq and Africa to cease insurgency became the paradigm for later large-scale campaigns during the Second World War, and has been reinvented in the age of asymmetric warfare against non-state insurgencies: once again in Iraq and Afghanistan – and, indeed, anywhere that a drone can reach.

The problem, as Hippler knows, is that this type of bombing does not work. A century of trying to find the right aerial platform and armament, from the German Gotha bombers of 1917 to the unmanned missile carriers of today, has not delivered the political and strategic promise that air-power theorists hoped for. Air power is at its best when it is either acting as an ancillary to surface forces or engaged in air-to-air combat. The Israeli strike against Arab air forces at the start of the 1967 war was a classic example of the efficient military use of air power. In the Second World War, the millions of bombs dropped on Europe produced no social upheaval, but the US ­decision to engage in all-out aerial counterattack in 1944 destroyed the Luftwaffe and opened the way to the destruction of Germany’s large and powerful ground forces.

The prophet of bombing as the means to a quick, decisive solution in modern war was the Italian strategist Giulio Douhet, whose intellectual biography Hippler has written. Douhet’s treatise The Command of the Air (1921) is often cited as the founding text of modern air power. He believed that a more humane way to wage war was to use overwhelming strength in the air to eliminate the enemy’s air force, and then drop bombs and chemical weapons in a devastating attack on enemy cities. The result would be immediate capitulation, avoiding another meat-grinder such as the First World War. The modern nation, he argued, was at its most fragile in the teeming industrial cities; social cohesion would collapse following a bombing campaign and any government, if it survived, would have to sue for peace.

It has to be said that these views were hardly original to Douhet. British airmen had formed similar views of aerial power’s potential in 1917-18, and although the generation that commanded the British bomber offensive of 1940-45 knew very little of his thinking, they tried to put into practice what could be described as a Douhetian strategy. But Douhet and the British strategists were wrong. Achieving rapid command of the air was extremely difficult, as the Battle of Britain showed. Bombing did not create the conditions for social collapse and political capitulation (despite colossal human losses and widespread urban destruction) either in Britain, Germany and Japan, or later in Korea and Vietnam. If Douhet’s theory were to work at all, it would be under conditions of a sudden nuclear exchange.

Hippler is on surer ground with the continuity in colonial and post-colonial low-­intensity conflicts. Modern asymmetric warfare, usually against non-state opponents, bears little relation to the total-war school of thinking, but it is, as Hippler stresses, the new strategy of choice in conflicts. Here too, evidently, there are limits to the bombing thesis. For all the air effort put into the conflict against Isis in Syria and Iraq, it is the slow advance on the ground that has proved all-important.

The most extraordinary paradox at the heart of Hippler’s analysis is the way that most bombing has been carried out by Britain and the United States, two countries that have long claimed the moral high ground. It might be expected that these states would have respected civilian immunity more than others, yet in the Second World War alone they killed roughly 900,000 civilians from the air.

The moral relativism of democratic states over the century is compounded of claims to military necessity, an emphasis on technological innovation and demonisation of the enemy. For all the anxieties being aired about militant Islam, the new Russian nationalism and the potential power of China, it is the United States and Britain that need to be watched most closely.

Richard Overy’s books include “The Bombing War: Europe (1939-1945)” (Penguin)

This article first appeared in the 16 February 2017 issue of the New Statesman, The New Times