14 The Economist June 4th 2022
Letters
Fairer elections for Britain
Bagehot set out the democratic
tragedy of how millions of
British citizens regularly see
their votes play a limited role,
or no role at all, in general
election results (May 14th).
Elections should be held with a
fair voting system where seats
match votes. Proportional
representation could clear
away a lot of the over-thinking
and tactical voting that goes
into elections. It might also
allow parties to see the posi-
tive aspects of co-operation
(something blindingly obvious
to most citizens) and to offer a
range of candidates who reflect
the actual community, not the
fantasy world of strategists
obsessing about being seen as
the masters of the universe
over voters in marginal seats.
If progressive parties do
work together on behalf of
their voters then voting reform
must emerge to heal British
politics. The Conservatives
have nothing to fear. We’ve
seen how other parties to their
right, like ukip, have impacted
on election results. After all, it
is proportional representation
for the parliaments in Scotland
and Wales that keep the Con-
servatives alive as a political
force in those places. However,
political gamesmanship is a
second-order consideration.
The most important is to
ensure that elections perform
their principle function: to
translate accurately the demo-
cratic will into democratic
representation.
darren hughes
Chief executive
Electoral Reform Society
LondonTracking people’s health
As general practitioners and
tutors of evidence-based medi-
cine, we found your Tech-
nology Quarterly on the future
of wearable devices in health
care (May 7th) to be interest-
ing, but also concerning. There
is an assumption that more
information, whatever it is,
must inevitably be good. In the
future, evidence might show
that the constant monitoring
of biometrics makes peoplehealthier. We suggest that this
is not the case now.
Biometric monitoring, as
with any testing of the healthy,
is a form of screening. History
has taught us that it is the
exception, rather than the rule,
for screening to be of net bene-
fit. The United States Preven-
tive Services Task Force and
Britain’s National Screening
Committee have recommend-
ed screening for only three
cancers, and even those are not
without controversy. They do
not recommend screening for
atrial fibrillation, the condi-
tion that you mentioned; it
seems the risks and benefits
are finely balanced.
The predictive value of any
test depends on how likely the
condition is to begin with, as
well as the characteristics of
the test. The rarer the condi-
tion is initially, the more likely
a “positive” result is a false
positive. Atrial fibrillation is
rarest in the younger pop-
ulation who use such health-
monitoring devices, and the
predictive value is probably
very low. Even monitoring in
symptomatic patients can
prove to be unhelpful. A recent
randomised control trial found
no benefit of saturation
monitoring on outcome in
people with covid-19.
We suggest that there is
“Fitbit Feedback Syndrome”,
which occurs when the aware-
ness of a biological variable
being measured causes anxiety
in a patient. This then drives a
change in the variable, leading
to a negative feedback loop. An
example would be fitness
trackers, where a focus on a
fast heart rate causes anxiety,
driving that rate ever higher. It
is a driver of over-medical-
isation. We predict a future
increase in incidence.
dr alex burns
dr edmund jack
Penarc
ExeterWearables can lead to accurate
diagnoses based on small
variations in the wearer’s
physical condition that
wouldn’t cause any harm if
undetected. Indeed, unneces-
sary treatment and being
labelled “sick” can cause realharm, including in precisely
the conditions you mentioned,
such as diabetes, hypertension
and kidney disease. Moreover,
doctors are not trained to
respond to new and often
unregulated data. The extra
burden of data generated by
wearables impacts the amount
of time they spend with
patients. The rise of wearables
is part of the wider datafica-
tion of health care. This agenda
is being promoted to save
money, but there is no evi-
dence to suggest that it does.
dr christoffer
bjerre haase
phdfellow in datafication
of the clinic
University of CopenhagenYou stated that people with
panic disorders “breathe in a
particular way that leads to a
build-up of carbon dioxide”.
Actually, the opposite is true;
hyperventilating decreases the
carbon level. We can all make
ourselves feel very uncomfort-
able quickly by hyperventilat-
ing for a short time.
dr geoffrey ainsworth
VancouverNotes on India
You acknowledged the pro-
gress achieved by India, who-
ever is the country’s helmsman
(“India’s next decade”, May
14th). All the development that
is happening is inclusive. But
the Western media’s bias
against India is well known
and you tried to make a moun-
tain out of the molehill of
single incidents of communal
fracas in India. You painted
India as a country not safe for
minorities, ie, Muslims. A
dispassionate analysis reveals
that Muslims are more safe in
India than China, France,
Germany and other countries.
Your convenient polemic
ignored the ethnic purging of
Kashmiri Pandits (Hindus).
p.s.s. murthy
Hyderabad, IndiaOnly at the end of your briefing
do you mention the persecu-
tion of the Muslim minority
(“A new formula”, May 14th).
The Hindutva focus and target-
ed attacks on Muslims andChristians form the Achilles’
heel of Narendra Modi’s auto-
cracy in reality. And there is
Kashmir, where the population
is held down by a force of
approximately 700,000 sol-
diers. For India to develop on a
sustained basis and earn the
respect of the world, it
deserves an inclusive leader
with strong moral standing. Mr
Modi is no such leader.
malik sarwar
New YorkPut your feet up at work
Bartleby’s take on the mixing
of business and leisure (May
7th) was foreseen by Dave
Frishberg, a jazz composer and
pianist. His song “Quality
Time” is about a couple who
combine business and vaca-
tion. It ends: “I’ll fax you back
with a plan of attack to let the
quality time begin; we’ll firm
up the timeline, and you can
pencil me in.”
james wooster
Lake Tapps, WashingtonAs portmanteaus go, “bleisure”
is certainly word vomit. But
Bartleby’s term for the mixing
of play and work, “plork”, is
also an offensive word in
Dutch, an anagram of prachtig
lichaam, onmeunige rotkop. The
gentlest way of interpreting
this in English is “Nice Legs
Shame About Her Face” the
title of a song by The Monks
from 1979 which somehow
made the British charts.
damian beasley-suffolk
Newcastle-upon-TyneThe mixing of business travel
with pleasure, unhappily
dubbed “bleisure“, reminded
me that many of us have long
practised just the opposite.
Those who have resolutely
remained at the office mix
leisure with business and call
it “leisiness”.
morgan christen
Epiquerez, SwitzerlandLetters are welcome and should be
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