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Interview: Alan Silman, rheumatologist and epidemiologist

03 December 2021

‘It is a shame that I was brought up being ashamed of my religion in the wider world’

I was interested in rheumatology because it’s a speciality which covers patients over their journey with a long-term disease which has multiple problems. Each patient is different. The many different diseases we study are linked by their impact on people’s lives, but not in terms of causes.

There’s an interesting debate about what “cure” means. We can cure very few chronic diseases, but there are effective treatments. We can cure some infections with antibiotics, but in many instances it’s about control. With arthritis, fibromyalgia, and so on, people can become symptom-free, in remission, off-treatment, but “cure” implies that it will never rear its head again, and that’s more challenging.

I don’t think doctors are necessarily healers. But understanding the psychological antecedents of ill health is vital in terms of guiding management of symptoms — for example, by CBT, mindfulness, and so on.

Epidemiology is intellectually challenging, because it’s a discipline that uses data to make conclusions about free living populations. The pandemic has been massive for epidemiology. It’s performed well in terms of applying our trade in a very new area. It’s performed challengingly where we have cut corners to get results out too quickly.

At this stage in my career, much of my work is interdisciplinary, and I enjoy teaching most. I teach Oxford university medical students and medical students doing postgrad degrees. When you teach, the response is instantaneous, unlike research, which takes time to plan and come to fruition.

I’m also aware, from my own experience, that the way a message gets across can be inspirational — change the way you think, act, behave. I like to think I’ve developed some methods to do that, and my students’ feedback is so positive that I feel I’m doing something useful. Face-to-face teaching is interaction — not just imparting facts: there’s two-way feedback. I’m happiest when I know I have inspired someone.

A doctor is, in part, a teacher of patients, yes. People come with an issue in their lives, and they need to understand about it and have it explained. Nowadays, thought, the doctor-patient relationship has to be much more of a conversation. We’re no longer telling patients what to do. The patient is taking control, and using the doctor as a resource — a process which had been better understood in field of education.

I’ve also presented sessions at Limmud, and now I’ve joined the board. Limmud’s an annual winter festival of Jewish learning, which began in the UK and has now spread throughout the world. It’s open to all Jewish denominations and anyone else interested.

One of the things that makes Limmud stand out is that everyone’s a teacher and everyone’s a learner, and the whole thing is built on the concept of volunteering. My father was a PoW in Japan, and inspired me with the way his companions, before things got too bad, set up a university. Everyone had something to teach: foreign languages, car maintenance, cooking, music. . . Limmud’s like that. Most people have something they have an interest in, which many of us haven’t thought about, and it can expand our horizons.

Sometimes I hear inspirational speakers in areas that passed me by. I regret not taking much more interest in classical history and archaeology as a schoolboy — the Bible as history. I was brought up as an observant Orthodox Jew not to challenge anything. Limmud is to challenge, and some of the things we’d never have challenged can be discussed now.

A lot of the content has a Jewish theme, though sometimes it’s quite tenuous. I’ve presented on the genetics of being Jewish. Are Jewish people genetically different? It’s a fascinating journey in medical literature. Maybe a lot of geneticists are Jewish? Of course, this touches on Nazi eugenics, but also differences between Jewish groups around the world.

There’s the persistent debate whether being Jewish is a religion or a race. Are the things we eat, wear, celebrate — are they shared religious belief or cultural heritage?

Sections of the Orthodox community in the UK feel that only by keeping to its strict tenets will Judaism survive; but Ephraim Mirvis has come to Limmud and been an popular attendee and speaker. The sessions are designed to be acceptable to people who keep Orthodox rules. Of course, one group who are completely self-excluded are the ultra-orthodox Haredi community, who are going to be the largest Jewish group because of their high birth-rate and low rate of intermarriage.

People who come to Limmud come with an openness about gender equality. Sexuality, and gender identity: that’s an interesting one. These debates are part of the programme, and it’s part of current discussions in the wider world.

Orthodox Judaism isn’t necessarily accepting of sex acts of people of same gender, but they are saying that gay people have to be accepted within the religion, and children should be taught acceptance in Jewish school. For child to commit suicide because of his or her sexuality is unacceptable.

One of the great Orthodox philosophers and thinkers at Limmud, Rabbi Lopez Cardozo, gave a compelling talk a few years ago saying that, in Jewish Halacha [law and jurisprudence], if someone is born gay, it’s not a choice, and they should be accepted. More recently, a girl from Haredi community in New York spoke of her experience at 18, when she realised that she couldn’t enter her arranged marriage, though she had no understanding of sexuality. Her parents kicked her out to sleep on a bench in Central Park until she was taken in by a charity which helps Haredi children who have come out. She remains Ultra-Orthodox, saying: “I believe Ha Shem brought me into the world to love him in the way I can love him. He knows the person I am, and I’m not going to change.”

Proportionately, the number of rabbis in the Progressive world is very high. The rabbi of our own synagogue here in Manchester is gay, but the fact that his same-sex partner is not Jewish was more of a problem to the committee.

Limmud was online last year, and will be again this year. There were lots of debates about the pluses and minuses about this. The face-to-face interaction is lost, but people are reluctant to travel, and it’s not a trivial expense. Our range of speakers can be much wider.

My parents were both born in England, and I grew up in Leeds, in the ’50s and ’60s. My father’s brother married someone who came on the Kindertransport, but she kept her story to herself. When you were Jewish then, you kept your head down. Some people changed their names. One accepted the structural anti-Semitism at school — it was probably same for black and minority-ethnic groups — the so-called banter from classmates and teachers. I didn’t think it was wrong: I thought it was the price you had to pay for being Jewish in a non-Jewish world.

One morning, all the Jewish boys were slippered by the teacher. I hated taking time off for festivals, because you had to catch up on work and you were singled out. I’ll never forget the chemistry class when the teacher said: “Welcome, back, Silman. Now tell us: was yesterday a feast day or fast day?” to guffaws from the class. I wanted the floor to open up and swallow me.

I’m not defending it, but it made me resilient. Sadly, there are reports in the news every day about racist tweets, and so on. It is a shame that I was brought up being ashamed of my religion in the wider world. When my own son invited his non-Jewish schoolfriends to his bar mitzvah and explained what it would be like, one boy said: “It sounds cool.” I’d have done anything to have my schoolfriends so accepting.

Our family home is in Manchester, but when I was president of Arthritis Research UK, I bought a flat in London; and when I’m in Oxford, I stay in my college or in London. So I’m perpetually on a train. With Covid, I wasn’t travelling anywhere, and doing everything on Zoom. Life was easier, but I missed face-to-face contact with students.

My first experience of God was when I was about to have an anaesthetic before an emergency operation.

Intolerance and fake news make me angry.

I love music, for sure, especially opera. Mozart’s operas: Cosi, The Magic Flute.

Yes, I do have hope for the future, because we are a more caring society.

I pray most for discussion and tolerance. We often think of things in a binary way. To me, that’s not the case.

If I were locked in a synagogue for a few hours with any companion, I’d choose Grayson Perry. He’s a wonderful human being. His Reith Lectures debunked a lot of snobbery about art, and a lot of his art is about his view of real people. He’s had this wonderful exhibition of lockdown art done by professionals and ordinary members of the public, with commentary about why they did it. He’s somebody who gets art to talk about life.

Professor Silman was talking to Terence Handley MacMath.


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