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    In conversation with Dr Xand

    Dr Xand on children's television, public health, and the coronavirus crisis.

    Dr. Alexander van Tulleken has Covid-19. He told me as much down the phone, explaining that no other disease could explain the symptoms he was suffering from. He had a persistent cough and a fever, the standard symptoms, but he had also lost his sense of taste and smell. This was before that was widely accepted as a key symptom, but he was certain that it was important. “Anecdote is more powerful tool in medicine than we give it credit for,” he explains, noting that although studies had not proved a conclusive link between loss of sensation and the disease, reports from South Korea strongly suggest that one exists. In a post-truth world, the suggestion that our trust should be placed in anecdotes may raise some eyebrows, but Xand, as he’s usually known, knows what he’s talking about.

    While he may be best known as the presenter of programmes like Operation Ouch and The Twinstitute, Dr. Xand also has an impressive medical background. With qualifications from Somerville College and Harvard Medical School under his belt, he made a name for himself as an editor of the Oxford Handbook of Humanitarian Medicine, and a senior research fellow at Fordham University, New York. His career as a senior medical analyst has seen him report on health crises around the globe, covering the Ebola epidemic in the United States and working with the World Health Organisation, Merlin, and other significant health charities.

    “I was quite lazy at school,” he says, “I would have loved to do an English degree or a History degree, but I would have sunk without a trace.”  He points to the nature of the degree as one of the key reasons he wanted to study medicine, arguing that he needed the structure to keep him on track. There was also a family element involved. “There’s this sort of reinforcing virtuousness about saying that you want to be a doctor,” he laughs, “people start to treat you like a doctor when you’re fifteen.”

    You would think that children’s telly would be the undignified, silly, boring, weird bit of a person’s career… instead it’s literally the most intellectually stimulating.”

    Perhaps this explains why Xand and Chris (his identical twin brother) followed such similar paths. Both hold medical degrees from Oxford University, and both studied Tropical Medicine afterwards. Intriguingly, they both started presenting at the same time, doing a documentary series called Medicine Men Go Wild, which examined indigenous medicine. Since then they have worked together on several television projects, most famously Operation Ouch.

    “There was never a moment when either of us went ‘I’m going to pivot to presenting’” says Xand, making it clear that his main interest is still humanitarian medicine. However, that hasn’t stopped him from presenting an impressive selection of programmes. “We got asked to do more stuff,” he explains, “we had a strange thing that we were twins, and twins are very useful on telly because… you have a built-in relationship that can be very silly or antagonistic and still be comfortable.”  The Van Tulleken twins put this relationship to full use in many of their shows, acting as human ‘lab-rats’ for experiments ranging from alcohol intake to acupuncture.

    The twins are probably best known for their children’s series Operation Ouch, a science show on CBBC that Xand describes as the “most intellectually demanding, morally engaging, complicated, scientifically accurate thing on the telly.” More on that in a moment. Asked whether he changes his register to get his ideas across the children who watch the shows, he laughs. “On BBC 2 I would be reluctant to use the word ‘hypothesis’ whereas on Operation Ouch we use it routinely.” Children who don’t understand something, he explains, keep watching, whereas adults tend to switch off.

    Operation Ouch is, according to Xand, pitched at the level of first-year medical students. While this may seem ludicrous, his justification makes it clear that he isn’t joking. “You would think that children’s telly would be the undignified, silly, boring, weird bit of a person’s career… instead it’s literally the most intellectually stimulating.” Navigating topics like alcohol, sex, and gender while remaining both appropriate and completely inclusive is no mean feat. The brothers manage impressively, discussing concepts as advanced as saltatory nerves and iron channels without ever deviating from the juvenile humour that characterises the show.

    “Public Health England (PHE) has one of the most difficult jobs in the world at the moment.”

    Getting messages about health and wellbeing out to the population has never been more important than it is right now. I asked Xand his thoughts on the government’s response to the Covid-19 pandemic as someone who has been delivering public health messages to the UK for years. He immediately refuted my suggestion that his work was primarily concerned with public health. “Most of what we’re trying to make,” he responded, “is entertainment… I try not say ‘here’s how to live your life.’”

    True as that may be, he hasn’t shied away from public health work in the current circumstances. Since the start of the pandemic, he has appeared as a medical advisor on several television shows, responding to questions on BBC’s Newsround and filming a documentary about self-isolation for Channel 4. Despite his modesty, he is clearly more than qualified to comment on the government’s response.

    “I think that Public Health England (PHE) has one of the most difficult jobs in the world at the moment.”  Although he concedes that many of the publications published by PHE aren’t as visually appealing as they could be, he also reminds me that “that isn’t their job.” Instead, the organisation has to put out clear material for local community leaders to reinterpret in ways that will accommodate for everyone in Britain. The respect he has for PHE’s response to the crisis is audible, he takes the opportunity to emphasise the unique difficulties of planning such a response.

    “In doing the messaging correctly,” says Xand, “the government will look bad and chaotic… You think ‘well, that’s terrible communication’ but it’s not. That’s perfect public health.” This is how Xand explains the Prime Minister’s seemingly sudden decision to put the country into ‘lockdown’. Public health announcements clearly change our behaviour, often in a way that helps the virus spread. In keeping information to themselves for the good of the country, the government’s response looks more piecemeal and disorganised than it actually is. In other words, “PHE are doing a much better job than they can ever get credit for”.

    “In doing the messaging correctly,the government will look bad and chaotic… You think ‘well, that’s terrible communication’ but it’s not. That’s perfect public health.”

    The coronavirus crisis will not treat everyone equally, Xand is brutally honest about that. “I think we are going to get a massive tension between desperate attempts to slow the spread of the virus and the absolute desperation of people who are already in extreme poverty or who have fallen into extreme poverty. For many people, the big consequence of this virus will be a plunge into poverty from which they cannot escape.”

    The long-term problems associated with this pandemic will be more to do with economics than health, and the short-term victims of the lockdown certainly won’t be the politicians. There’s a whole social element to the crisis as well: many people will inevitably be trapped with their abusers and single parents will have to juggle a daunting set of tasks that now includes home-schooling.

    Since this interview took place, Xand has made a full recovery. He continues to answer the nation’s questions on television, providing a reassuring, expert presence in a world of terrifying news and ill-informed WhatsApp oracles. The UK, however, continues to see cases rise in line with Xand’s tentative predictions. He made another prediction, this time that the coronavirus was “spreading unchecked” in Africa. As Africa’s total confirmed cases exceeds 10,000 and lockdowns are implemented across the continent, his words ring true. His consistent ability to interpret the direction makes me wish that he hadn’t made any more predictions. Unfortunately, he did.

    “We’ll recover from Covid-19,” says Xand, “unfortunately, I think this is not the big one. I think in our lifetime we will see worse pandemics.” Coming from anyone else, this would seem like an alarmist conspiracy theory. But it’s coming from Dr. Xand, and he clearly knows what he’s talking about.

    Readers questions:

    When is the UK going to return to normality? – Ayesha Khan

    “This will leave a very significant scar in everyone’s minds and some people’s bodies in the way that huge global events like September 11th often do. Life goes back to normal, but not quite. We will get our lives back, for sure. Most people are happy to get on the train and go to the park with this virus circulating, so clearly this is not a virus that will in itself change our behaviour. Our behaviour is being changed by rules and regulations and as soon as those are lifted to some extent our lives will go back to normal. I would say the next twelve weeks are going to be really, really unpleasant in terms of what we see on the news. In the end the virus is not stoppable in any proper way, we can slow it down but the health service will inevitably be overwhelmed. I would think that by the end of the summer with testing increased and more knowledge about the denominator we are going to have a much clearer picture of how to respond. I would think that in a year’s time things will look very much better for most people.”

    Is there going to be a dramatic rethink of the economy after Covid-19? – Sam Millward

    “No. I think basically people are idiots and as a species, we’re doing an absolutely terrible job of everything. What’s a slightly more intellectual way of phrasing that? There have always been heroic people throughout history who we’ve ignored: The Labour Movement, the Civil Rights Movement, the Women’s Rights Movement. So many people have resisted the bad forces of greed and capitalism through the centuries but essentially, we have built a world which seems to require its own destruction and I don’t believe we’ll stop doing that. If you look at our behaviour with regard to climate change, if you look at the way we ran the economy post-2008 we seem absolutely unwilling to put long-term benefit over short-term gain. Given our willingness to ignore things that are definitely going to happen and be bad for us, climate change being the obvious example. I feel very, very pessimistic about our ability to change anything significant.”

    Responses have been edited for length and clarity, interview conducted on Wednesday 25th March.

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