Show Hide image

A right pig’s ear

The government panicked over the threat of swine flu – and got its response completely wrong

Brace yourself - swine flu is on the rise again. The second wave coincides with mounting disquiet among doctors about the way we as a nation are responding to the disease. A recent survey by Pulse, a leading GP periodical, found that 61 per cent of family doctors believe the government should review its policy of blanket provision of Tamiflu to all suspected sufferers. It also reported a growing number of cases that have resulted in death or serious harm after conditions such as meningitis have been misdiagnosed as flu, and wrongly treated.

Swine flu has wrong-footed everyone. For many years it was assumed that when the next pandemic arrived, it would create havoc: thousands would die in Britain alone; the exponential demand for services would be mirrored by the decreasing number of healthy doctors able to deliver them; societies would crumble. This projection was based in part on the 1918 global flu pandemic - which caused an estimated 50 to 100 million deaths - coupled with the high fatality rate among the few hundred cases of "bird flu" (H5N1) over the past few years.

In the UK, huge quantities of antiviral drugs were stockpiled, plans for establishing a national pandemic flu phone line were laid, and organisations both public and private were exhorted to draft detailed contingency plans for when the carnage began. Both chambers loaded, the shotgun was trained on the far horizon, the collective eye of the viral surveillance world squinting down the barrel, seeking out the first sign of an emergent threat.

Along came swine flu (H1N1). To be clear: people have died - 82 in the UK and an estimated 4,041 worldwide, at the time of writing. According to the World Health Organisation (WHO), roughly 60 per cent of the severe or fatal cases have occurred in recognised risk groups, such as people with grave underlying health problems; the remaining 40 per cent have affected fit children and adults. Each death is tragic, but the mortality figures are tiny, viewed against the millions of mild cases globally.

Writing in the British Medical Journal in September, Peter Doshi, a doctoral student at the Massachusetts Institute of Technology, proposed a framework to differentiate between disease patterns. Type 1 infections are widespread and severe - exactly the kind towards which the current pandemic flu plans are geared. But swine flu sits in Doshi's type 3 - widespread but usually mild. These different beasts present different challenges, but because pandemic planning failed to anticipate anything other than a type 1 scenario, swine flu has triggered a completely inappropriate response.

Marginal effects

Central to doctors' unease is the National Pandemic Flu Service (NPFS). Telephone-based and web-based assessments of symptoms are made using a computer algorithm. If the computer says "swine flu", patients are given antiviral medication, usually Tamiflu. The problems are twofold.

First, data from the Health Protection Agency, which conducts confirmatory laboratory tests on a sample of cases, shows that less than 10 per cent of NPFS diagnoses are correct. The other 90 per cent of supposed swine flu sufferers have other illnesses whose symptoms happen to overlap. (Doctors fare only slightly better, diagnosing at best a quarter of cases accurately.) Second, the drugs being doled out are by and large worse than useless, even in the correctly diagnosed cases. Tamiflu makes only a marginal difference to the course of uncomplicated flu and causes side effects in up to 40 per cent of people who take it. On the whole, these are just bothersome - vomiting is the most frequent - but serious, even fatally adverse reactions do occasionally occur.

In late August, WHO advised that antivirals were not necessary for fit patients suffering from uncomplicated swine flu. The Department of Health defends its continued policy of Tamiflu-for-all on "safety first" grounds. Its concern is those exceptional cases of severe disease in fit individuals, where Tamiflu might (no one knows for sure) make a difference if started early. However, the logic - that it is better to treat everyone than risk missing those who might have benefited - belongs to a strategy for dealing with a Doshi type 1 pandemic, where the chance of severe disease is high. For swine flu, damage from indiscriminate use of antivirals outweighs the supposed benefits of catching atypical cases early.

The real challenge of a Doshi type 3 pandemic is identifying the small minority who actually and urgently require help. These could be those rare individuals with severe flu, or they might be patients in the early stages of another serious disease such as meningitis. Doctors are good at doing this (though far from infallible) and many GPs believe that only medically qualified staff should be undertaking flu assessments, but this is not achievable, given our capacity for mass hysteria. During the first wave of swine flu - before the NPFS was launched - the NHS front line was overwhelmed by waves of worried callers in flu hot spots. One of the main reasons for setting up the NPFS was to prevent a meltdown in services, but it should now change its focus from diagnosing swine flu (at which it is hopeless) to identifying patients in trouble.

The trickiest problem is when patients who initially feel mildly unwell start to deteriorate. The Department of Health stresses that patients are advised to consult a doctor if they get worse, but this fails to appreciate the Tamiflu effect. Having been "diagnosed" with swine flu and put on antivirals, patients are then falsely reassured that appropriate treatment is under way. By stopping its blanket use of Tamiflu, the NPFS would greatly increase the likelihood of patients consulting a doctor if they deteriorate.

Lessons in planning

Swine flu may in time be seen as a great learning opportunity. It has exposed a rigidity in pandemic planning that needs urgent correction. WHO has a scale to denote the spread of in­fection - level six being pandemic. It needs to develop a simple, parallel system to differen­tiate between Doshi types, one that should trigger responses appropriate to the particular challenge posed.

For now, the Department of Health should stop sticking doggedly to contingencies laid against a very different threat. The public and the NHS need clear identification of the at-risk groups and a message that the danger of swine flu, for everyone else, is almost certain to be minimal. They also need information about the warning signs of a more serious problem. The vast stocks of antivirals should be left on the shelf to go quietly out of date.

Yet it may be too late. Another facet of the Tamiflu effect is that we have educated hordes of people that what they thought felt like just a bad cold (and, most of the time, was just a bad cold) needed treatment with powerful drugs involving mystical rituals with a special authorisation number and a flu friend. Doctors will be dealing with mass hysteria in the face of ­minor illness for some time to come.

Phil Whitaker is a doctor and novelist. He is currently working on his fifth novel, "Sister Sebastian's Library"

 

Computer says flu

What do malaria, meningitis, diabetic coma, leukaemia and appendicitis have in common? They are just a few of the conditions that were originally diagnosed as swine flu during the first wave of the pandemic. Most patients have lived to tell the tale; some have not. The case reports have been appearing in the letters pages of medical journals, and on discussion forums of networking sites for doctors. The GPs reporting them are frequently unsure who in authority should be informed.

In fact, the National Patient Safety Agency (NPSA) has been tasked by the Department of Health with investigating alleged misdiagnoses. In a statement, John Scarpello, NPSA deputy medical director, confirmed that the agency had received "a small number of reports where swine flu may have been misdiagnosed", but was unwilling to go into detail while the facts had not been established. Given that the reporting system is entirely voluntary, and few clinicians know to contact the NPSA, this "small number" of reports is likely to be the tip of an iceberg.

The National Pandemic Flu Service is a first: never before have patients been diagnosed by computer or unqualified call-centre staff. There is a real need for research to examine this approach, yet none appears to be planned. The Department of Health refers inquiries about patient safety to the NPSA, while the NPSA believes commissioning such a study would be outside its capacity and brief.

Phil Whitaker

This article first appeared in the 12 October 2009 issue of the New Statesman, Barack W Bush

Creative Commons
Show Hide image

Starting Star Wars: How George Lucas came to create a galaxy

On the 40th anniversary of the release of the original Star Wars, George Lucas biographer James Cooray Smith shares the unlikely story of how the first film got made.

While making THX 1138 in 1970, writer/director George Lucas told composer Lalo Schifrin that he wanted to make a Flash Gordon picture, an updating of the 40s sci-fi serials that he’d enjoyed as a child. It would, however, be those serials not as they were, but how he remembered them as having been. When the rights to these proved unavailable, he began to work on original idea, hoping to create something similar, but which he would own himself.

In January 1973, after completing his 50s nostalgia picture American Graffiti but before its release, Lucas began his outline for this space adventure. The first line of this near-incomprehensible document was The Story of Mace Windu. Mace Windu, a revered Jedi-Bendu of Opuchi who was related to Usby CJ Thape, Padewaan learner to the famed Jedi.’

"Jedi" was a word Lucas had coined to describe a clan of warrior mystics who were essential to his story. A man whose fascination for Japanese cinema had become a general interest in Japanese cultural history, he’d named them after the branch of Japanese drama that drew moral and instructive lessons from stories set in the past – Jidai geki.

This version is set in the thirty-third century and features a teenage Princess, droids, an Evil Empire and a grizzled Jedi warrior, General Skywalker, whose plot role resembles Luke’s from the finished film, although his character is Obi-Wan Kenobi’s. It climaxes with a space dogfight and ends with a medal ceremony. Among the planets named are Alderaan (here the Imperial capital) and Yavin, at this point the Wookiee homeworld. Some characters from this draft (Valorum, Mace Windu) would eventually find a home in The Phantom Menace more than twenty years later.

By May Lucas had a 132 page script, The Adventure of Anikin Starkiller. Skywalker had acquired the forename Luke but was no longer the protagonist. This was Anikin (sic) Starkiller, one of the sons of General Skywalker’s old comrade, the partially mechanical renegade Kane Starkiller. Anikin had to protect a Princess, aided by two robots R2-D2 and C-3PO.

Lucas had worked backwards from Flash Gordon, looking to uncover the source of his appeal, hoping to transfer it to his own story. Once he’d worked his way through the comic strips of Gordon’s creator Alex Raymond, he tackled Edgar Rice Burroughs, Jules Verne and Edwin Arnold’s Gulliver on Mars. Conversations with his New Hollywood peers about the archetypes thrown up by his reading – and which he increasingly saw everywhere – brought him into contact with Joseph Campbell’s then newly published Myths to Live By (1972) an anthology of lectures and essays from a man who devoted his career to identifying the basic archetypal characters and situations which he felt underpinned all human mythologies.

"The book began to focus what I had already been doing intuitively" Lucas later said, an idea which seemed to him to itself reinforce Campbell’s contention that such archetypes and situations dwelled in a collective unconsciousness. Lucas expanded his reading to epics of all kinds, and began planning a visual style that would combine the vistas of Japanese master director Akira Kurosawa with the kind of static-camera realism which he’d used on American Graffiti.

Lucas wanted over-exposed colours and lots of shadows, but shot in a way that made them seem unremarkable. Seeing the Apollo missions return from the moon "littered with weightless candy bar wrappers and old Tang jars, no more exotic than the family station wagon" had illustrated to him the problem with every fantasy movie ever made. Their worlds never looked like people lived in them. His film would depict a "used future". Describing the aesthetic he’d sought to American Cinematographer he explained: "I wanted the seeming contradiction of…fantasy combined with the feel of a documentary."  To Lucas Star Wars wasn’t science fiction, it was "documentary fantasy".

There was only one studio executive Lucas thought had any hope of understanding what he was trying to do, Fox’s Alan Ladd Jr, son of the late actor. Like Lucas and his contemporaries in New Hollywood, Ladd was a man driven by a love of cinema. Lucas could communicate with him through a shared vocabulary, describe a planned scene as being like something from The Searchers (John Ford, 1956) or Fahrenheit 451 (Francois Truffaut, 1966) and be understood. Ten days after his presentation to Ladd, they signed a development deal. Fox agreed to pay Lucas $15,000 to develop a script, plus $50,000 to write the movie and another $100,000 to direct it, should it actually be made. American Graffiti associate producer Gary Kurtz was named as Producer for Star Wars, and received $50,000.

The script development money gave Lucas enough to live on whilst he continued work on the screenplay. As he did so it changed again; a ‘Kiber Crystal’ was written in and then written out. Skywalker became Deak Starkiller’s overweight younger brother before becoming the farm boy familiar from the finished film. Characters swapped names and roles. A new character named Darth Vader – sometimes a rogue Jedi, sometimes a member of the rival ‘Knights of Sith’ – had his role expanded. Some drafts killed him during the explosion of the Death Star, others allowed him to survive; across subsequent drafts his role grew. Some previously major characters disappeared altogether, pushed into a "backstory", Lucas choosing to develop the practically realisable aspects of his story.

This is an important clarification to the idea that Star Wars was "always" a part of a larger saga, one later incarnated in its sequels and prequels. That’s true, but not in an absolutely literal way. Star Wars itself isn’t an excerpted chunk of a vast plotline, the rest of which was then made over the next few decades. It’s a distillation of as much of a vast, abstract, unfinished epic as could be pitched as a fairly cheap film to be shot using the technology of the mid 1970s. And even then much of the equipment used to make the film would be literally invented by Lucas and his crew during production.

In August 1973 Graffiti was released and became a box office sensation, not only did the profits make Lucas rich (he became, at 29, a millionaire literally overnight) its success meant that Lucas was able to renegotiate the terms of his Fox deal. Rather than making demands in the traditional arenas of salary and percentages Lucas wanted control of the music, sequel and merchandising rights to his creations. Fox conceded him 60 per cent of the merchandising, aware of its potential value to them, but eventually agreed that Lucas’s share would rise by 20 per cent a year for two years after the film’s release. Few films made money from spin-off products for a whole 24 months, and Star Wars would surely be no different. Lucas got the sequel rights as well, albeit with the proviso that any sequel had to be in production within two years of the film’s release or all rights would revert to Fox.

Most important amongst Lucas’ demands was that, if it went ahead, he wanted the film to be made by his own company, not by Fox. That way he could control the budget and ensure all charges and costs made to the production were legitimately spent on the film. The experience of watching Mackenna’s Gold being made while a student on placement a decade earlier had taught him just how much money a studio could waste, and on a film like Star Wars – which was both ambitious and would inevitably be under-budgeted – it was crucial that this did not happen. Control of the music rights also had a sound reason behind it. Universal were making a fortune out of an American Graffiti soundtrack that was simply a repackaging of old hits featured in the movie. Of the profits of this Lucas saw nothing despite having selected the tracks featured and fought long and hard for their inclusion in his film.

In March 1975, Ladd took Lucas’ draft to the Fox board. They passed it and budgeted the film at $8.5m. Characters bounced in and out of that script right up to the preparation of the shooting draft, dated 15 January 1976. This was tailored to be as close to the film’s proposed budget as possible, and contain as many of the ideas, characters and situations Lucas had spent the past few years developing as he considered feasible.

This draft is the first version of the script in which Kenobi dies fighting Vader. Previously he had been injured, but escaped with Luke’s party. Alec Guinness, who had already been cast, was initially unhappy with this change, but was persuaded by Lucas that a heroic death followed by appearances as a spectral voice would prove more memorable to audiences than his spending the last third of the film sitting on Yavin whilst the X-Wings went into battle.

Filming began on location in Tozeur, Tunisia on 22 March 1976. Before shooting Lucas sat his crew down and made them watch four films which he felt between them defined what he was after in Star Wars. Stanley Kubrick’s 2001 (1969), Douglas Trumbull’s 1975 Silent Running, Sergio Leone’s Once Upon a Time In the West and Fellini’s Satyricon (Both 1969). The Leone picture was full of the sun-blasted vistas Lucas wanted to evoke for Tatooine, and the Fellini film, with its aspects of travelogue and attempts to portray an entire society in a fly-on-the-wall manner gave an idea of the "documentary fantasy" approach the director was so keen on. All four films shared one vital element: they’re windows onto lived-in worlds remarkable to audiences but regarded as ordinary by the film’s characters.

The first scenes shot for Star Wars were those of Luke buying Artoo and Threepio from the Jawas outside his foster parents’ home. Producer Kurtz had allowed 11 days for the shoot, after that a borrowed army C130 Hercules was scheduled to pick up the cast and crew.

A few days into shooting, creature make-up man Stuart Freeborn was taken ill and had to be flown back to Britain where he was diagnosed with pneumonia. Other crew members contracted dysentery. On 26 March Tunisia experienced its first winter rainstorm for half a century, damaging equipment and exterior sets delaying filming of key scenes.

Lucas wanted the stormtroopers to ride ‘dewbacks’, dinosaur-like domesticated beasts that allowed the troops to move across the desert. One dewback was built, out of foam rubber stretched over a wire frame. It could only be used in the background and no one was ever seen riding one. The other live animal Lucas wanted to portray was a Bantha, a huge horned, shaggy beast reminiscent of a prehistoric mammoth. It was to be the mode of transport for the Tusken Raiders, faintly Bedouin, vaguely mechanically-enhanced humanoids who attacked Luke in the Jundland wastes. In the end, creating the beasts proved impossible, and while they were referred to in dialogue in scenes that were shot (‘bantha tracks…’) none of their sequences were lensed.

As hard as the shoot was on Lucas, he at least had an idea of what he was trying to do and how it would all fit together. The actors, suffering stomach troubles, sunburn and long days, were less clear. Anthony Daniels trapped inside an almost immovable fibreglass body suit suffered the worst. Twenty five years later he would give credit for helping him to get through the Tunisia filming to Alec Guinness. "He was incredibly kind to me…I firmly believe that I wouldn’t have completed that arduous task of shooting without him."

Once the Tunisian shoot was over, the cast moved to EMI Elstree Studios in Borehamwood, outside of London. Star Wars was being made in the UK because it wasn’t possible to shoot the film in Hollywood at that time, not that Lucas – with his lifelong disdain of LA itself – wanted to anyway. Star Wars required nine stages simultaneously, something that no Hollywood studio complex could guarantee at anything like sufficient notice. In March 1975 producer Kurtz had flown to Italy to look at studio space, but found nothing suitable. He then caught a plane to London, where Lucas joined him.

Together they scouted UK film studios. Pinewood was a possibility, but management insisted Lucasfilm hire their technicians, a condition which became a deal-breaker. Neither Shepperton nor Twickenham had enough sound stages (although the giant Stage H at Shepperton  - bigger than any stage at Elstree – would ultimately house one scene of the film) which left only EMI Elstree. Then losing £1 million a year, Elstree was being kept open more or less on the insistence of Harold Wilson’s government, whose allies in the Trades Union movement considered the closing of the facility unconscionable. Elstree had no staff, and anyone who wished to rent it had to supply their own technicians and much of their own equipment. Off-putting to many, it sealed the deal for Lucas and Kurtz, who wanted to move their own people in. They hired the facility for seventeen weeks starting at the beginning of March 1976.

To design and build the sets needed to turn to Elstree into a realisation of Lucas’s screenplay they hired John Barry, a British designer who had worked under Ken Adam on Barry Lyndon (Stanley Kubrick, 1975) a film Lucas admired enough to hire its costumier John Rollo as well.

Elstree’s two largest stages were given over to Mos Eisley Spaceport and the interior of the Death Star. Both the Mos Eisley hangar bay and the one inside the Death Star which replaced it on the same stage were constructed around the full size Millennium Falcon set created by John Barry’s protege Norman Reynolds. Built by Naval engineers at Pembroke Dock, Wales it was 65 feet in diameter, 16 feet high and 80 feet long. It weighed 23 tonnes.

The absence of Stuart Freeborn, still recovering from Tunisia, meant that most of the aliens seen in the Mos Eisley cantina sequence were completed by assistants and lacked any articulation at all. Unhappy with the scenes as shot, Lucas resolved to do to re-shoots back in the USA.

The last scenes to be shot were for the opening battle, as Vader and his stormtroopers boarded the blockade runner. With little time Lucas used six cameras, manning one himself (Kurtz manned another) and shot the sequence in two takes. The six cameras produced so many different perspectives on the action that even the duplicated events that are in the film are unnoticeable. The finished sequence, chaotic though the creation of it was, is amongst the best put together moments in the movie, a superb evocation of Lucas’ documentary fantasy approach, and the cameras dart in and out of the action like reporters shooting newsreel footage. Virtually the first live action seen in the picture, its style later went a long way towards convincing audiences that what they were seeing was somehow real.

Principal photography completed on 16 July 1976, although some re-shoots and pick up shots for the Tatooine sequences were undertaken in Yuma, Arizona in early 1977. Amongst those scenes shot were those featuring the Banthas. Lucas borrowed a trained elephant from Marine World, and had it dressed to resemble a more hirsute, fearsome pachyderm. Mark Hamill was unavailable to participate. He’d crashed his car of the Antelope Freeway in LA shortly before and was undergoing painful facial reconstructive surgery. Although Hamill should have been involved in the re-shoot, in scenes of Luke’s landspeeder moving across the desert, Lucas had no choice but to film them without him; he took a double to the shoot, dressed him in Luke’s costume and put Threepio in the foreground. Also re-shot, over two days in La Brea, California, were portions of the cantina sequence. New cutaways and background shots were filmed to be inserted into the Elstree footage in order to eliminate as of the unsatisfactory masks as possible.

While supervising editing of the film Lucas experienced chest pains, and was rushed to hospital where he was treated for a suspected heart attack. He was later diagnosed with hypertension and exhaustion, both exacerbated by his diabetes.

Fox were by now trying to book Star Wars into cinemas, and had picked a release date in May, long before the 4th July public holiday, long regarded as the opening weekend of summer. Fox wanted $10m in advance bookings for Star Wars, desperate to recoup an investment that internal studio sources had now decided was foolish. They secured less than $2m, and achieved that only by implying to theatres that they wouldn’t be offered Charles Jarrot’s much-anticipated The Other Side of Midnight if they didn’t sign up for Star Wars too. Before its release several exhibitors complained at this "block booking" and filed suits; Fox was later fined $25,000 for the practice, punished for forcing cinemas to agree to show something which was, by the time they paid the fine, the most financially successful movie ever made.

In early 1977 Lucas screened Star Wars for a group of friends, it was nearly finished – although the opening crawl was longer and many of the special effects shots were absent, represented instead by sequences from World War II films and real combat footage shot by the USAF. Among those present were Brian De Palma, Alan Ladd Jnr, Steven Spielberg and Jay Cocks. Martin Scorsese had been invited but troubles editing his own New York, New York meant he didn’t turn up.

De Palma hated Star Wars, and spent the post-screening dinner rubbishing it to anyone who would listen. Others present were unsurprised, De Palma had behaved in the same way during the group screening of Scorsese’s’ Taxi Driver; laughing loudly through Cybill Shepherd’s conversations with Robert de Niro, and at one point shouting "Shit!" halfway through a tense scene. Only Spielberg seemed impressed, and told Lucas that he thought Star Wars would take $100m. Lucas pointed out that nothing took $100m, and countered that Spielberg’s Close Encounters of the Third Kind would do better at the box office. The two directors wrote what they considered realistic estimations of what each other’s film would make in its first six months of release on the inside of matchbooks, which they then traded. By the time Lucas got round to opening Spielberg’s matchbook and saw the figure $33m in his friend’s scrawling hand Star Wars had already made ten times that.

Odd as it seems now, when every blockbuster is prefaced by months of breathless, unrelenting media "enthusiasm", Star Wars wasn’t released on a wave of hype or accompanied by an extensive marketing campaign. It was released (on 25 May 1977) to thirty-two screens, after a barely publicised premiere at Mann’s Chinese Theatre in Hollywood. It made $2.8m in its opening week, but didn’t receive a nationwide release for two months. Despite almost unprecedented success in preview screenings, Fox were still unsure of what to do with Lucas’ bizarre children’s film. Indeed it, only got a Hollywood opening at all because William Friedkin’s Sorcerer – which had been intended for this slot at Mann’s – wasn’t finished.

So negative had advance feeling about Star Wars been that Lucas left the country; he was still in LA on opening day, finishing the sound edit (he was unhappy with the copy playing downtown, and unknowingly embarking on a lifetime of revising his movie) but the next day he and his wife (and Star Wars film editor) Marcia flew to Hawaii, where they were joined by friends, including Spielberg and Amy Irving. It was an attempt to escape what Lucas felt would be the inevitable terrible reviews and wrath of the studio. Even when Ladd called him to share his excitement over the movie’s colossal opening weekend, Lucas was unmoved; all movies labelled science fiction did well in their first few days due to the business attracted by the neglected fanbase for such things. It was only when the film continued to do outstanding business and was expanded to more and more theatres that Lucas considered returning early from his holiday, and began to realise that the film he’d just delivered had changed his life.

As "Star Wars" expanded into more cinemas, and people began to queue round the block to see it, shares in Fox climbed from well under $10.00 to $11.50 each; over the next three months the value rose to $24.62, nearly trebling in price, such was the film’s value to the embattled studio. It was a magnificent vindication for Alan Ladd Jr, who had more than once had to intervene to stop colleagues closing down the film’s production completely. He had never lost faith in Lucas and his bizarre idea, but he was virtually the only person employed by Fox itself who hadn’t.

Just a few weeks before, as the end of the financial year approached, Fox had tried, and failed, to sell its investment in Star Wars to a German merchant bank as an emergency pre-tax write off.

0800 7318496